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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2. Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.3 Comprehensive Outpatient Rehabilitation Facilities (CORFs)and Outpatient Rehabilitation Facilities (ORFs) : 2.3.5 Speech Therapy

2.3.5
2.3.5.1
A procedural modifier is required when submitting claims for ST services. Providers must use modifier GN for ST services. Procedural modifiers are not required for evaluations and reevaluations.
Speech therapy evaluations (procedure code 92506) are limited to once every 180 calendar days, any provider. Speech therapy reevaluations (procedure code S9152) are limited once per 30 calendar days, any provider.
Speech therapy treatment codes 92507, 92508, and 92526 are payable in 15-minute increments at a maximum of eight units (two hours) per day.
All 15-minute increment procedure codes are based on the actual amount of billable time associated with the service. For those services for which the unit of service is 15 minutes (1 unit = 15 minutes), partial units must be rounded up or down to the nearest quarter hour.
The documentation retained in the client’s file must include the billable start time, billable stop time, total billable minutes, and activity that was performed.
To calculate billing units, count the total number of billable minutes for the calendar day for the client, and divide by 15 to convert to billable units of service. If the total billable minutes are not evenly divisible by 15, minutes greater than 7 are converted to 1 unit and 7 or fewer minutes are converted to 0 unit.
For example, 68 total billable minutes/15 = 4 units + 8 minutes. Since the 8 minutes are more than 7 minutes, those 8 minutes are converted to 1 unit. Consequently, 68 total billable minutes = 5 units of service.
Refer to:
Section 2.3.3, “Occupational Therapy” in this handbook for 15-minute conversion table.
Speech therapy evaluation and reevaluations will be denied when billed on the same date of service, any provider as procedure code 92507 and 92508 with modifier GN.
Procedure codes 92526 and 92610 may be considered for treatment and evaluation of swallowing dysfunctions and oral functions for feeding.
Procedure code 97535 is used for speech therapy services for training for augmentative communication devices.

Texas Medicaid & Healthcare Partnership
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