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December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 3 School Health and Related Services (SHARS) : 3.3 Services, Benefits, Limitations, and Prior Authorization : 3.3.9 Speech Therapy (ST) : 3.3.9.2 Description of Services

3.3.9.2
ST evaluation services include the identification of children with speech or language disorders and the diagnosis and appraisal of specific speech and language disorders. ST services include the provision of speech and language services for the habilitation or prevention of communicative disorders.
ST evaluation is billable on an individual (procedure codes 92521, 92522, 92523, and 92524) basis only. ST is billable on an individual (procedure code 92507) or group (procedure code 92508) basis.
Procedure codes 92521, 92522, 92523, and 92524 are limited to a total of 12 units and may be reimbursed for each client per provider in a 30-day period.
Procedure code 92522 will be denied if it is submitted with the same date of service as procedure code 92523.
Procedure code 92523 will be denied if it is submitted with the same date of service as procedure code 92522.
Providers can only bill time spent with the student present, including assisting the student with learning to use adaptive equipment and assistive technology.
Time spent without the student present, such as report writing and training teachers or aides to work with the student (unless the student is present during training), is not billable. Session notes are not required for procedure codes 92521, 92522, 92523, and 92524; however, documentation must include the billable start time, billable stop time, total billable minutes, and must note the activity that was performed (e.g., speech evaluation).
Session notes are required for procedure codes 92507 and 92508. Session notes must include the billable start time, billable stop time, total billable minutes, activity performed during the session, student observation, and the related IEP objective.

Texas Medicaid & Healthcare Partnership
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