96125
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
1.70
Facility
$102.87
Non-Facility
$102.87
Documentation Required
- Maintain all documentation in the patient’s medical record; every page must be legible, include patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.
- Documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
- The submitted medical record must support the use of the selected ICD-10-CM code(s).
- The submitted CPT/HCPCS code must accurately describe the service performed.
Key Coverage Criteria
- Speech-language pathology (SLP) services for treatment or evaluation of communication disorders when determined reasonable and necessary per LCD L35070.
- Selection and prescription of speech-generating devices should be billed with CPT code 92607.
- Adaptation and training for speech-generating devices should be billed with CPT code 92609.
- Report group therapy with CPT code 92508 when patients are not receiving direct one-on-one contact and are supervised by the therapist.
- Use the appropriate CPT evaluation code for re-evaluations in SLP because CPT does not define a distinct re-evaluation code.
- Skilled therapy services are covered when the skills of a qualified therapist are necessary to improve the patient’s current condition, to maintain the patient’s current condition, or to prevent or slow further deterioration.
20 Active Policies
L34646 — Psychological and Neuropsychological Testing
J05
A57481 — Billing and Coding: Psychological and Neuropsychological Testing
J05
L33631 — Outpatient Physical and Occupational Therapy Services
J06
A56566 — Billing and Coding: Outpatient Physical and Occupational Therapy Services
J06
Related Codes
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