G0161, Services performed by a qualified speech-language pathologist, in the home
HCPCS/CPT
Prior Authorization
Prior Auth Required
Code explicitly requires 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.
- Z96.21 Presence of cochlear implant status
11 Active Policies
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
AETNA-CPB-0243, Speech Therapy
AETNA-CPB-0646, Voice Therapy
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.