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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2. Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.10 Therapy Services (CCP) : 2.10.3 Speech Therapy (ST) : 2.10.3.2 Services, Benefits, and Limitations

2.10.3.2
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 evaluation (procedure code 92506) is limited to once every 180 calendar days, any provider. Speech therapy reevaluation (procedure code S9152) is limited to once every 30 calendar days, any provider.
Speech therapy treatment codes 92507, 92508, and 92526 are payable in 15-minute increments at a maximum of four units (one hour) 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:
Subsection 2.10.1, “Occupational Therapy (OT)” 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 codes 92507 and 92508 with modifier GN.
Procedure codes 92630 and 92633 are limited to two procedures per day, for different procedures, billed by the same provider or provider group.
Procedure codes 92526 and 92610 may be considered for reimbursement 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
CPT only copyright 2011 American Medical Association. All rights reserved.