Does 97551 require prior authorization?

No, 97551 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 97551?

Medicare facility rate: $21.04. Non-facility rate: $26.05. Work RVU: 0.54.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.54

Facility

$21.04

Non-Facility

$26.05

When billing with a Z-code as the diagnosis, document the orthotic/prosthetic device name, date the patient received the device, and the date training/teaching began (if applicable).
Document actual SLP patient contact time in 15-minute increments and link units billed to the clinical notes showing time and skilled service provided.
For SGD services billed with CPT 92607 or 92609, retain documentation supporting selection/prescription, adaptation, and training provided to the patient.
If performing a re-evaluation, document clinical rationale and use the applicable evaluation CPT code with supporting clinical findings since no separate SLP re-evaluation CPT exists.

Home health speech-language pathology services must be billed using HCPCS G0153 (Speech-Language Pathology).
When treating memory disturbances not associated with mental disorders (e.g., post cerebrovascular accident), use ICD-10 R68.89 as the diagnosis code for the related LCD.
Use CPT 92607 for selection and prescription of speech-generating devices (SGDs) and CPT 92609 for SGD adaptation and training.
Use CPT 92507 for speech/hearing treatment services (treatment code).
For re-evaluation in speech-language pathology, use the appropriate evaluation CPT code because CPT does not define a separate SLP re-evaluation code.
Occupational therapy is covered for patients with migraine (G43.xx) who require training to reduce pain during basic and instrumental activities of daily living, typically completed in 3–4 sessions.

A53052 — Billing and Coding: Home Health Speech-Language Pathology

A53057 — Billing and Coding: Home Health Occupational Therapy

A53058 — Billing and Coding: Home Health Physical Therapy

A53064 — Billing and Coding: Outpatient Occupational Therapy

A53065 — Billing and Coding: Outpatient Physical Therapy

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