2023 CPT Codes
| Service | Code |
|---|---|
| SLP Therapy CPT Codes |
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| SLP Eval Codes |
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| Other Eval/Assessment Codes: |
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| OT Therapy CPT Codes |
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| OT Eval Codes |
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| Targeted Case Management Codes |
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| PT Therapy CPT Codes |
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| PT Eval Codes |
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| Special Instructions Codes |
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| SLP CPT Code | Description | Notes/Example |
|---|---|---|
| 92507 | Speech Therapy: This code includes treatment of speech, language, voice, communication, and/or auditory processing disorders.2 | The individual patient undergoes developmental programs with SLP under the direction of a physician:
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| 92508 | Group speech-language: Communication Disorders6 | Group, two or more individuals. Reported when patients are not receiving direct one-on-one contact, but are being supervised by the therapist.6 |
| 92526 | Treatment of Swallowing: addresses swallow dysfunction and/or oral function for feeding.3 |
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| 92606 | Non-Speech Device Service: Therapeutic Services for the use of non-speech generating augmentative and alternative communication device (AAC) including programming and modification. | You should use 92606 only if you are working with the patient on how to use the tool itself and/or are modifying or programming it for their use. If the patient uses a device during speech-language treatment, use 92507 for the billing code.7 |
| 92609 | Speech Generating Device Servi: Therapeutic Services for the use of speech generating device including programming and modification. | You should use 92609 only if you are working with the patient on how to use the device itself and/or are modifying or programming it for their use. If the patient uses a device during speech-language treatment, use 92507 for the billing code.7 |
97129 *Can’t be used on same DOS as 92507* +97130 | Therapeutic Interventions: focus on cognitive function and compensatory strategies to manage the performance of an activity, direct (one-to-one) patient contact; initial 15 minutes. Therapeutic interventions that focus on cognitive function; each additional 15 mins.1 Needs to be reported along with 97129.5 | Cognitive function: attention, memory, reasoning, executive function, problem-solving, and\or pragmatic functioning Compensatory strategies: managing time or schedules, initiating, organizing and sequencing tasks 1 Once per day. Cannot be reported on the same DOS as 92507.5 |
SLP CPT Therapy Billing Resources
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| OT CPT Code | Description | Notes/Example |
|---|---|---|
| 97110 | Therapeutic procedure: Therapeutic exercise to develop strength and endurance, range of motion and flexibility (one or more areas, each 15 minutes). 1 | Functional mobility for ADLs or Mobility Related ADLs (MRADLs) are not included here. Remember, differentiate yourself form other professions here and explore how the therapeutic exercise translates and will help your client with their ADLs. 3 |
| 97530 | Therapeutic Activities: direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes. 1 | Generally involves intervention that includes -ing words: walking, running, climbing, throwing, with an emphasis on intervention focused fine and gross motor skills. |
| 97535 | Self Care: training and improving performance in ADLs (activities of daily living), working on compensatory strategies, using adaptive equipment, facilitating meal prep or self-feeding. 15 mins each. 1 | Generally ADLs and feeding. 3 Example: Instructing the patient on using sock aide for dressing. 6 Documentation requirements:
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| 97533 | Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-to-one) patient contact, each 15 minutes. 1 Therapy sessions are play-oriented and may include using equipment such as swings, trampolines, slides. Therapies may include deep pressure, brushing, weighted vests, and swings.5 | Supportive documentation requirements: Describe the treatment techniques used that will improve sensory processing and promote adaptive responses to environmental demands, and the patient’s response to the intervention, to support that the skills of a therapist were required. 4 Treatment to promote increase in tactile sense, vestibular sense (balance) that tells us how to position our bodies and heads, and proprioceptive sense (awareness of body in space) that helps us know what we do with our joints, muscles, and ligaments.5 |
| 97760 | Orthotic Management, first encounter: including assessment and fitting (when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes. 7 Clock times would only be for time spent training, and would not include assessing, measuring and/or fitting.6 | This procedure may be considered reasonable and necessary, if there is an indication for education for the application of orthotics, and the functional use of the orthotic is present and documented. 7 Ongoing visits to apply the device would be considered monitoring. Once the initial fit is established, any further visits would be billed as 97763.6 Not used for prefabricated/commercial (off the shelf) components like lumbar roll, non-customized supports, or multi-podus boots b/c they don’t require the skill of a therapist and are non-covered. Minor modifications to prefabricated orthotics do not constitute a customized orthoric.6 |
| 97763 | Orthotic/Prosthetic Checkout: An established patient obtaining the orthotic or prosthetic for use. 7 | Involves training with a prosthetic limb for walking, running, sitting, balancing, and standing with their prosthetic. Or if they have a new arm, they’d need to learn how to write, hold an object, wave, or grip. It also includes assessment for the prosthetic, fitting the patient for the limb, and teaching on how to remove it. However, the time it takes to create the prosthetic does not fall within this code for billing purposes. Involves evaluating the effectiveness of an existing device. A professional may recommend a change in the device or could determine a slight adjustment of the current one if it’s necessary. 7 |
97129 +97130 | Therapeutic interventions that focus on cognitive function and compensatory strategies to manage the performance of an activity, direct (one-to-one) patient contact; initial 15 minutes. Therapeutic interventions that focus on cognitive function; each additional 15 mins. 2 | Cognitive function: attention, memory, reasoning, executive function, problem-solving, and\or pragmatic functioning Compensatory strategies: managing time or schedules, initiating, organizing and sequencing tasks. 2 |
OT CPT Therapy Billing Resources
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| PT CPT Code | Description | Notes/Example |
|---|---|---|
| 97110 | Therapeutic Procedure: Therapeutic exercise to develop strength and endurance, range of motion and flexibility (one or more areas, each 15 minutes). 2 | This is any type of exercise that develops strength and endurance in one or more areas. The exercises also help with range of motion and flexibility. 1 |
| 97116 | Gait Training: includes sequencing, training using a modified weight-bearing status, employing assistive devices, and completing turns with proper form. 2 | If you are using this code, make sure you are focusing on the biomechanics of the gait cycle in some form or another. Having a patient walk in order to improve cardiovascular health is not considered gait training. 2 |
| 97530 | Therapeutic Activities: direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes. 1 | Generally involves intervention that includes -ing words: walking, running, climbing, throwing, with an emphasis on intervention focused fine and gross motor skills. |
| 97533 | Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-to-one) patient contact, each 15 minutes. 6 Therapy sessions are play-oriented and may include using equipment such as swings, trampolines, slides. Therapies may include deep pressure, brushing, weighted vests, and swings.7 | Supportive documentation requirements: Describe the treatment techniques used that will improve sensory processing and promote adaptive responses to environmental demands, and the patient’s response to the intervention, to support that the skills of a therapist were required. 5 Treatment to promote increase in tactile sense, vestibular sense (balance) that tells us how to position our bodies and heads, and proprioceptive sense (awareness of body in space) that helps us know what we do with our joints, muscles, and ligaments.7 |
| 97535 | Self Care: training and improving performance in ADLs, working on compensatory strategies, using adaptive equipment, facilitating meal prep or self-feeding. 15 mins each. 1 | Generally ADLs, use of assistive technology devises or adaptive equipment, and feeding. 2 Documentation requirements:
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| 97129 | Therapeutic interventions that focus on cognitive function and compensatory strategies to manage the performance of an activity, direct (one-to-one) patient contact; initial 15 minutes. Therapeutic interventions that focus on cognitive function; each additional 15 mins. 4 | Cognitive function: attention, memory, reasoning, executive function, problem-solving, and\or pragmatic functioning Compensatory strategies: managing time or schedules, initiating, organizing and sequencing tasks. 4 |
| 97760 | Orthotic Management, first encounter: including assessment and fitting (when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes. 3 Clock times would only be for time spent training, and would not include assessing, measuring and/or fitting.5 | This procedure may be considered reasonable and necessary, if there is an indication for education for the application of orthotics, and the functional use of the orthotic is present and documented. 3 Ongoing visits to apply the device would be considered monitoring. Once the initial fit is established, any further visits would be billed as 97763.5 Not used for prefabricated/commercial (off the shelf) components like lumbar roll, non-customized supports, or multi-podus boots b/c they don’t require the skill of a therapist and are non-covered. Minor modifications to prefabricated orthotics do not constitute a customized orthoric.5 |
| 97763 | Orthotic/Prosthetic Checkout: An established patient obtaining the orthotic or prosthetic for use. 3 | Involves training with a prosthetic limb for walking, running, sitting, balancing, and standing with their prosthetic. Or if they have a new arm, they’d need to learn how to write, hold an object, wave, or grip. It also includes assessment for the prosthetic, fitting the patient for the limb, and teaching on how to remove it. However, the time it takes to create the prosthetic does not fall within this code for billing purposes. Involves evaluating the effectiveness of an existing device. A professional may recommend a change in the device or could determine a slight adjustment of the current one if it’s necessary. 3 |
PT CPT Therapy Billing Resources
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| OT Eval Codes | Description | Notes/Example |
|---|---|---|
| 97165 | OT Eval Low Complexity: Patient presents with no comorbidities that affect occupational component. Typically, 30 mins are spent face-to-face with the patient and/or family. 1 | This code requires an occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; an assessment(s) that identifies 1-3 performance deficits that result in activity limitations and/or participation restrictions, and clinical decision making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem-focused assessment(s), and consideration of a limited number of treatment options. 1 |
| 97166 | OT Eval Moderate Complexity: Patient may present with comorbidities that affect occupational performance minimal to moderate modification of tasks or assistance with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 45 mins are spent face-to-face with the patient and/or family. 1 | This code requires an occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current functional performance; an assessment(s) that identifies 3-5 performance deficits that result in activity limitations and/or participation restrictions; and clinical decision making of moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment(s), and consideration of several treatment options. 1 |
| 97167 | OT Eval High Complexity: Patient presents with comorbidities that affect occupational performance. Significant modification of tasks or assistance with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 60 mins are spent face-to-face with the patient and/or family. 1 | This code requires an occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional performance; an assessment(s) that identifies 5 or more performance deficits that result in activity limitations and/or participation restrictions; and clinical decision making of high analytic complexity, which includes and analysis of the patient profile, analysis of data from comprehensive assessment(s), and consideration of multiple treatment options. 1 |
| 97168 | OT Re-Evaluation: Requires an assessment of changes in patient functional or medical status with revised Plan of Care, and update to the initial occupational profile to reflect changes in condition or environment that affect future interventions and/or goals, and a revised Plan of Care. Formal reevaluation is performed when there is a documented change in functional status or a significant change to the Plan of Care is required. Typically, 30 mins are spent face-to-face with the patient and/or family.2 | Re-evals are separately reimbursable when the medical record supports that the patient’s clinical status or condition required the additional evaluative service. When medical necessity is supported, a re-eval is appropriate and is separately billable for:
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| SLP Eval Codes | Description | Notes/Example |
|---|---|---|
| 92523 | SLP Evaluation (Language & Speech): Apply modifier 52 if eval of language only. 4 | Evaluation of speech sound production (articulation, phonological process, apraxia, dysarthria) WITH evaluation of language comprehension and expression (receptive and expressive language). 4 Cannot be billed on same DOS as 92522.11 |
| 92522 | SLP Eval (Speech Sound Production): | Evaluation of articulation, phonological process, apraxia, dysarthria, etc. Cannot be billed on same DOS as 92523.11 |
| 92610 | Feeding consultation/swallowing: Evaluation of oral and pharyngeal swallowing function.7 | 2 usually allowed per calendar year.8 Included as part of the evaluation can be assessment with a continuum of food/liquid consistencies, time spent addressing compensatory strategies, and patient and family/caregiver education. 12 Can be billed on the same DOS as 92526 if documentation clearly show the eval and treatment are separate and distinct services and that the treatment addresses an established POC.12 |
92605 +92618 | SLPEV RX NONSpeech-generat AAC: Evaluation for prescription of non-speech-generating augmentative and alternative communication device (AAC); first hour.13 For additional time in 30-minute increments.13 | An AAC evaluation may include the following individualized assessments of the patient’s:
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92607 +92608 | SLP EV RX for face to face AAC: Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour. 13 For additional time in 30-minute increments. 13 | This code describes the services to evaluate a child to specify the speech-generating device recommended to meet the needs and capacity. 13 |
| PT Eval Codes | Description | Notes/Example |
|---|---|---|
| 97161 | PT Eval Low Complexity: No personal factors and/or comorbidities, addressing 1-2 elements, stable clinical presentation with low clinical decision making complexity. Typically 20 mins face-to-face. 10 | For the typical patient, includes all the necessary eval tools, including range of motion and manual muscles testing. These codes are typically consultative, and it’s expected that the administration of these tests will generate material that will be formulated into a report, which should clearly indicate the purpose and rationale for the test, the test performed with results and how the info affects the treatment plan.9 |
| 97162 | PT Eval Moderate Complexity: 1-2 personal factors and/or comorbidities, addressing 3 or more elements, evolving clinical presentation with moderate clinical decision making complexity. Typically 30 mins face-to-face.10 | For the typical patient, includes all the necessary eval tools, including range of motion and manual muscles testing. These codes are typically consultative, and it’s expected that the administration of these tests will generate material that will be formulated into a report, which should clearly indicate the purpose and rationale for the test, the test performed with results and how the info affects the treatment plan.9 |
| 97163 | PT Eval High Complexity: 3 or more personal factors and/or comorbidities, addressing 4 or more elements, unstable clinic presentation with high clinical decision making complexity. Typically 45 mins face-to-face.10 | For the typical patient, includes all the necessary eval tools, including range of motion and manual muscles testing. These codes are typically consultative, and it’s expected that the administration of these tests will generate material that will be formulated into a report, which should clearly indicate the purpose and rationale for the test, the test performed with results and how the info affects the treatment plan.9 |
| 97164 | Physical Therapy Re-Eval: | Re-evals are separately reimbursable when the medical record supports that the patient’s clinical status or condition required the additional evaluative service. When medical necessity is supported, a re-eval is appropriate and is separately billable for:
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| Other Eval Codes | Description | Notes/Example |
|---|---|---|
96112 +96113 | Developmental Eval: Developmental test administration, 1st hour. 4 Each additional 30 mins. | Includes assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed, with interpretation and report. 4 |
| 96156 | Health and Beh Assessment: (96156) Can only be used by a Clinical Psychologist (CP).6 Health-focused clinical interview, behavioral observations, clinical decision making.6 | (96150 is discontinued) RT automatically changes to CPT: 96156 per 1/1/20 code change. 5 Used to identify the psychological, behavioral, emotional, cognitive, and social factors important to the prevention, treatment, or management of physical health problems.6 |
| T2023NB | Non-Bill Eval | Focuses on needs identification through the process of assessment, both to determine eligibility and the need for any medical, educational, social, and/or other services. |
Evaluation/Assessment CPT Billing Resources
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| TCM CPT Code | Description | Notes/Example |
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| T2023FSC | FSC |
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| T2023IF | IFSP Dev |
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| T2023TR | Transition Conference |
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| T2023IN | Intake |
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| T2023 | Screening |
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| SI CPT Code | Description | Notes/Example |
|---|---|---|
| T1027 | Dev Services |
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| T2027S | Social Work |
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| T1027V | Vision SI |
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Diagnosis Codes
The following can be used prior to enrollment only:
Z05.9 = Those under 1 years old > Dx code prior to enrollment (initial IFSP visit)
Z00.7 = intake notes of those over 1 yrs old and do not have a current diagnosis code prior to enrollment
Z00.70 = eval note of someone who didn’t qualify and were within normal limits
When developing the Plan of Care the following codes that may be used for those children demonstrating a delay but records do not provide a diagnosis from the physician—this is not an exhaustive list:
- R62.0 for delayed milestones
- F84.0 for autistic disorder
- F80.1 for expressive language
- F80.2 for mixed receptive-expressive language
- F80.4 for speech and language delay due to hearing loss
- F82 for specific dev. delay of motor function
- H90.__ for hearing loss codes
The following may be used with children under age 12 months:
- P04._ : newborn affected by maternal use of ____
- P05._ : newborn gestational age __
- P07._ : extremely low birth weight newborn ___ grams / preterm newborn gestational age ___
Helpful information about Down Syndrome/Trisomy-21
Q90.9 = down syndrome, unspecified