Does 95857 require prior authorization?

No, 95857 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 95857?

Medicare facility rate: $23.71. Non-facility rate: $67.47. Work RVU: 0.52.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.52

Facility

$23.71

Non-Facility

$67.47

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.
SLP assessment and development of a plan of care (POC) must be documented with clinical history, objective measurements, subjective evaluations, and specified treatment goals.

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.
Outpatient speech-language pathology (SLP) services are covered when necessary for diagnosis or treatment of speech, language, cognitive-communication, voice, auditory processing, and swallowing disorders that result in communication disabilities.
SLP services are covered for acquired etiologies including stroke, brain tumor, traumatic brain injury, anoxic or toxic encephalopathy, nondegenerative and degenerative neurologic diseases including dementias.

A56868 — Billing and Coding: Outpatient Speech Language Pathology

L34429 — Outpatient Speech Language Pathology

AETNA-CPB-0107 — Chiropractic Services

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