CPT Code 92526 for Feeding Therapy

CPT code 92526 is an important code for speech-language pathologists (SLPs) who provide feeding therapy services. This code allows SLPs to bill for the treatment of swallowing dysfunction and oral feeding issues. However, to use CPT code 92526 correctly, it is essential to understand what this code entails.

Key Takeaways on CPT Code 92526:

• CPT code 92526 is for the treatment of swallowing disorders and oral feeding dysfunction by speech therapists.
• It is a non-timed code that can be billed once per day per patient.
• Proper documentation is required to show medical necessity when billing 92526.
• Common errors include using 92526 for evaluations, billing it more than once daily, and lack of documentation.
• Payment rates vary by payer but the national fee for 92526 in 2023 is $83.64.
• Following CPT guidelines and ASHA resources helps avoid claim denials.

What is CPT Code 92526?

CPT, or Current Procedural Terminology, codes are used by healthcare providers to bill insurance companies for services provided. These codes are maintained and updated annually by the American Medical Association (AMA).

CPT code 92526 falls under the category of “Special Otorhinolaryngologic Services” and has the following long description:

Treatment of swallowing dysfunction and/or oral function for feeding, one-on-one patient contact, each additional 15 minutes, with or without electrical stimulation

This means that 92526 is used by speech therapists to bill for direct one-on-one treatment focused on improving a patient’s ability to swallow safely and effectively. It also covers treatment to improve oral motor skills needed for feeding.

How Do I Bill My CPT 92526?

CPT code 92526 is intended for the treatment of swallowing and feeding disorders. It should not be used for the evaluation of these issues. Separate CPT codes exist for swallowing/feeding evaluations (e.g. 92610).

92526 is a non-timed code. This means it can be billed once per day per patient, regardless of the length of the treatment session. You cannot bill 92526 multiple times in one day for one patient.

Since 92526 is not timed, duration should not be indicated on claims. Simply report one unit of 92526.

Proper documentation is required when billing 92526. Your notes should clearly demonstrate that you provided skilled treatment for swallowing dysfunction and/or feeding issues. Avoid vague documentation.

What is the Difference Between 92610 and 92526?

It is important to understand the difference between 92526 and 92610:

• 92610 – This code is for the evaluation of oral and pharyngeal swallowing function. You would use 92610 for the initial swallow evaluation.
• 92526 – This code is for the treatment of swallowing disorders and feeding dysfunction. You use 92526 for individual therapy sessions focused on these issues.

Both codes refer to swallowing function. But 92610 is the assessment, while 92526 is the actual hands-on treatment.

What is the ICD-10 Code for 92526?

ICD-10 diagnosis codes must be reported along with CPT procedure codes like 92526.

Commonly reported ICD-10 codes for dysphagia treatment include:

• R13.10 – Dysphagia, unspecified
• R13.11 – Dysphagia, oral phase
• R13.12 – Dysphagia, oropharyngeal phase
• R13.13 – Dysphagia, pharyngeal phase
• R13.14 – Dysphagia, pharyngoesophageal phase

Feeding issues may be billed with diagnoses such as:

• R63.3 – Feeding difficulties
• R63.4 – Abnormal weight loss

Select the ICD-10 code that most accurately reflects the patient’s specific swallowing or feeding disorder.

What is the Reimbursement Rate for 92526?

Reimbursement rates for CPT code 92526 vary by payer.

According to the national physician fee schedule, the facility price for 92526 in 2023 is $83.64.

However, the allowed amount will depend on the patient’s insurance plan. State Medicaid programs and Medicare contractors also set their own payment rates.

Therapists should verify the 92526 reimbursement rate for each payer they bill. Signing up for electronic remittances will allow you to easily track how much you are paid.

How Do I Avoid Errors When Using 92526?

To avoid costly claim denials and reimbursement issues, therapists should be aware of the following common errors with CPT code 92526:

• Billing 92526 for evaluations: Only use this code for treatment. Use 92610 for dysphagia/feeding evals.
• Billing 92526 more than once per day: Bill just one unit of this code per patient per day.
• No documentation to support billing: Records must demonstrate treatment for swallowing/feeding.
• Reporting time: Do not indicate session length, since 92526 is non-timed.
• Using 92526 for non-skilled services: Feeding assistance and supervision are non-billable.

Carefully following all CPT guidelines for 92526 will help prevent problems. Also reach out to payers if you have questions on their policies.

Changes to Code 92526

The AMA updates CPT codes annually, usually in October. Any changes made to code 92526 would take effect January 1st of the following year.

It’s critical that SLPs stay up-to-date on the latest CPT guidelines. CPT changes and clarifications are published in the CPT Manual. The online ICD-10 Lookup tool is also updated regularly.

Resources for Proper CPT Code Use

To ensure proper use of CPT code 92526, consult authoritative resources including:

• AMA CPT Codebook: Provides guidelines on using and billing codes. Updated annually.
• ASHA Medicare fee schedule: Lists Medicare reimbursement rates and policies. Updated annually.
• Online CPT lookup tool: Allows you to search and view full code details.
• Payer billing guidelines: Review each insurance provider’s policies. Contact them with questions.
• TheraPlatform: Offers billing services and supports correct 92526 usage.

Following these key resources can help avoid claim denials and ensure proper reimbursement for your services. Be proactive about staying up-to-date on changes affecting CPT codes you frequently use.

Conclusion

CPT code 92526 is an important billing code that allows speech therapists to be reimbursed for providing vital feeding and swallowing treatment. However, to successfully utilize this code, SLPs must understand key guidelines:

• Use 92526 specifically for dysphagia/feeding treatment sessions.
• Bill only once per patient per day.
• Provide detailed documentation to support billing.
• Verify payer policies and reimbursement rates.
• Consult CPT and ASHA resources to avoid errors.

With an accurate understanding of code 92526, speech therapists can feel confident submitting claims and being fairly compensated for their skilled services treating swallowing and feeding disorders.