When children are in their developmental stages, they may exhibit various disorders. Some of the most common are speech and language disorders. Approximately 7.2% of children in the U.S. aged 3-17 have experienced a disorder related to their voice, speech, or language in the last 12 months.
There are professional therapists and speech-language pathologists (SLPs) who address this issue through therapy and other methods. But do they bill their services? By using CPT code 92523! If you are curious about what this code is about, its relevant modifiers, and how to bill it correctly, then continue to read this guide.
CPT Code 92523 – Description
So, what does CPT code 92523 actually represent?
This code specifies an evaluation process of speech and language. During this service, a pathologist takes a patient’s history and conducts standardized assessments to diagnose various speech and language disorders, such as:
- Articulation or phonological disorder
- Aphasia
- Dysarthria
- Dysphonia
However, keep in mind that this code does not cover a general evaluation. It particularly involves a diagnostic service for issues listed above.
Scenarios Where CPT Code 92523 is Applicable
Let’s look at some real-life examples to understand the correct application of CPT code 92523.
Articulation Disorder
As we have mentioned above, the prevalence of speech and sound disorders is quite common in children. Almost 8-9% of children suffer from articulation disorders or phonological disorders.
So, consider a scenario where a woman brings her 5-year-old son to a speech-language pathologist. She tells the therapist that her son is having difficulties in making specific sounds since he began talking. He often mispronounces certain letters. The SLP performs a thorough evaluation to identify any articulation disorder. Since the therapist is performing evaluations and standardized tests for both speech and language, he can utilize CPT code 92523 to bill for this assessment.
Phonological Disorder
Suppose a 7-year-old child has had difficulty forming words since childhood. He was unable to pronounce some words correctly. Initially, his parents thought his speech would improve with time. But now, the child suffers in school when communicating with his peers.
So, his parents see a speech and language pathologist for his treatment. The SLP evaluates the speech and language to diagnose a phonological disorder. This will help in creating a customized therapy plan tailored to the child’s specific needs. In this case, the SLP can bill his services with CPT code 92523.
Aphasia
Aphasia can occur due to any condition that harms your brain, as well as issues that interfere with its functioning. Approximately 2 million individuals in the United States currently live with aphasia.
So let’s imagine a man in his late 60s suddenly develops a speech and language disorder. His family consults his physician, who refers him to a speech and language pathologist. The therapist starts by taking the patient’s history, which reveals that he had experienced a traumatic brain injury in a car accident some years ago. The physician suspects that the patient may have an aphasia attack. So he conducts the necessary assessment of his speech and language comprehension to determine the problem and develop a treatment plan. For the evaluation of his condition, the SLP can charge the services using CPT code 92523.
Applicable Modifiers for CPT Code 92523
Commonly, there are very limited modifiers that can be used with CPT code 92523, and modifier GN is one of them. Nevertheless, you may also use modifier 59 if you are providing other services on the same day as the speech and language evaluation.
Modifier GN
The GN modifier is used to indicate that the service was part of an outpatient speech-language pathology plan of care. So, if you rendered the service in an SLP clinic, you can apply this modifier with CPT code 92523.
Modifier 59
You can only apply modifier 59 with CPT code 92523 if you provided distinct services on the same day as the SLP evaluation. However, you must justify the medical necessity of both services through documentation.
CPT Code 92523 – Billing & Reimbursement Guidelines
You can follow these guidelines to bill CPT code 92523.
Bill 92523 Correctly
It is crucial to comprehend the correct application of CPT code 92523, which pertains to the evaluation of speech and language within a single session. If you are performing an assessment focused solely on articulation without a language analysis, this code cannot be utilized. In such cases, the appropriate code to use is 92522. Therefore, prior to submitting claims for your services, it is essential to verify that the CPT code you are using aligns with the services provided.
Provide Proper Documentation
Ensure your documentation is precise and thorough, as it will support the medical necessity of your services and establish the basis for payment. The initial and most important aspect to incorporate is the relevant ICD-10 codes for CPT code 92523, specified by Medicare, to demonstrate the necessity of the services provided. Justify the applicable modifier, and then include essential details about the patient, such as their name, medical history, and presenting issues.
Follow Payer-Specific Policies
Each insurance payer has its unique guidelines for reimbursing services outlined in their policy manuals. It is crucial for coders and billers to stay informed about any updates to their policies and reimbursement rules. Medicaid and Medicare Part B provide coverage for this test. However, it is necessary to verify whether or not private insurance payers cover this service.
Final Word
It’s time to wrap up our blog! To summarize, CPT code 92523 pertains to a speech and language assessment performed by a speech-language pathologist to diagnose issues related to speaking and language comprehension. We have shared some examples that further clarify the proper use of this code. Additionally, it is essential to indicate (with modifier GN) that the assessment was carried out as part of an outpatient SLP care plan.
Lastly, the billing and reimbursement guidelines provide further details on how to accurately bill the code, including attaching necessary documentation and reviewing the payer’s guidelines.
If you still have concerns or queries, we strongly recommend seeking professional behavioral health RCM services for streamlined billing.
