Does 92520 require prior authorization?

No, 92520 does not require prior authorization (low confidence). No active coverage policies found for this code.

What is the Medicare reimbursement rate for 92520?

Medicare facility rate: $32.40. Non-facility rate: $90.85. Work RVU: 0.73.

HCPCS/CPT

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Work RVU

0.73

Facility

$32.40

Non-Facility

$90.85

Document evaluations and re-evaluations and bill re-evaluations using the evaluation CPT code (per policy guidance).
Document selection/prescription and programming/modification of speech-generating devices and use CPT 92607/92608 for selection/prescription and CPT 92609 for programming/modification on claims.
Claims and coding must follow the complementary Local Coverage Determination (LCD L34429) guidelines referenced in this policy.
The IDTF must have Palmetto GBA provider enrollment approval listing the specific CPT/HCPCS codes the facility is authorized to bill for Medicare beneficiaries.

Coverage for programming and modification of speech-generating devices using CPT 92609.
Coverage for individual outpatient treatment of speech, language, voice, communication, and/or auditory processing disorders using CPT 92507.
Coverage for group outpatient treatment (2 or more individuals) of speech, language, voice, communication, and/or auditory processing disorders using CPT 92508.
Coverage for selection and prescription of speech-generating devices (SGDs) using CPT 92607 and 92608.
An IDTF must be credentialed and approved by Palmetto GBA provider enrollment to bill Medicare for a specific diagnostic procedure or material.
Additional services and supplies (e.g., radiopharmaceuticals, special contrast agents, medications) are payable to an IDTF when the diagnostic test itself is payable and the supplies are commonly separately reimbursed to a physician in an office setting.

A56868 — Billing and Coding: Outpatient Speech Language Pathology

A58559 — Billing and Coding: Independent Diagnostic Testing Facilities (IDTF)

L34429 — Outpatient Speech Language Pathology

ANTHEM-MED.00002 — MED.00002 Selected Sleep Testing Services

BCBSIL-MED204.004 — Rhinomanometry, Acoustic Rhinometry, Optical Rhinometry and Acoustic Pharyngometry

Ask Verity about documentation requirements, denial risks, or coverage in your state.