G0161 — Services performed by a qualified speech-language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech-language pathology maintenance program, each 15 minutes
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- 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.
Key Coverage Criteria
- 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.
- Speech-language pathology (SLP) services are covered to improve or restore cognitive functioning, communication skills, and feeding skills after congenital or acquired disease or injury, and to maintain function or slow deterioration when skilled care is required.
11 Active Policies
AETNA-CPB-0243 — Speech Therapy
AETNA-CPB-0646 — Voice Therapy
ANTHEM-CG-REHAB-12 — CG-REHAB-12 Rehabilitative and Habilitative Services in the Home Setting: Physical Medicine/Physical Therapy, Occupational Therapy and Speech-Language Pathology
ANTHEM-CG-MED-23 — CG-MED-23 Home Health
A53052 — Billing and Coding: Home Health Speech-Language Pathology
Related Codes
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