CPT Code 96105 for Assessment of Aphasia

CPT code 96105 is an important billing code for speech-language pathologists who perform assessments of aphasia and cognitive-linguistic deficits. This code properly captures the work involved in testing patients for language and neurocognitive disorders. Correct usage of 96105 allows SLPs to receive reimbursement for these skilled services.

Key Takeaways on CPT Code 96105:

• CPT 96105 is for assessment of aphasia and neurocognitive performance.
• It covers test administration and scoring by the SLP.
• 96105 is billed in hourly increments based on the assessment duration.
• Documentation must support medical need for testing.
• Medicare reimbursement averages $124 per hour for 96105.
• Private payer rates vary so SLPs should verify coverage and fees.

What is CPT Code 96105?

The Current Procedural Terminology (CPT) code set is maintained by the American Medical Association to standardize medical billing.

CPT code 96105 falls under the category of “Psychological and Neuropsychological Testing” with the following description:

Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, e.g., by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour.

Code 96105 specifically covers assessments that analyze speech, language, cognitive-linguistic abilities, and neuropsychological skills in patients suspected of having aphasia or cognitive deficits from neurological conditions like stroke or brain injury.

How Do You Bill for CPT Code 96105?

There are several key guidelines for billing CPT code 96105:

• 96105 is billed based on the amount of time for the assessment. Each hour is billed as one unit.
• Time for administering and scoring tests is included in 96105.
• Documentation must justify medical necessity for the evaluation.
• Only face-to-face time with the patient counts towards 96105 time.
• 96105 cannot be billed for informal screenings or treatment.

Billing incrementally for the total assessment time allows SLPs to capture the full extent of their services when testing patients with complex linguistic disorders.

Medicare Reimbursement Rates

Medicare reimburses an average of $124 per hour for CPT code 96105 nationally. However, actual reimbursement varies by Medicare Administrative Contractor (MAC) and region.

Private insurers set their own payment rates for procedures covered by 96105. Verifying coverage policies and fee schedules with each payer is important.

Appropriate ICD-10 Diagnosis Codes

An ICD-10 diagnosis code must be included on claims to indicate the medical reason for testing covered by 96105.

Common ICD-10 codes reported with this CPT code include:

• R47.01 – Aphasia
• F01.50 – Vascular dementia without behavioral disturbance
• F02.80 – Dementia in other diseases classified elsewhere without behavioral disturbance

The chosen ICD-10 code should accurately reflect the condition necessitating a skilled assessment.

Avoiding Errors When Using 96105

To avoid costly claim denials and payment issues, be aware of these common 96105 billing errors:

• Not documenting sufficiently to prove testing is medically necessary.
• Billing for informal screenings rather than thorough assessments.
• Forgetting to list time increments matching the total assessment duration.
• Listing multiple units on one date but only performing one test.
• Failing to obtain proper preauthorizations from payers when required.

Updated CPT Codes

The AMA updates CPT codes annually, usually around October, with changes taking effect January 1st. Checking for revisions to commonly used codes ensures billing remains accurate.

Accessing current code descriptions, guidelines, and reimbursement rates through the AMA or MAC fee schedules is key to correct billing.

Resources for Proper CPT Code 96105 Usage

To ensure appropriate application of CPT code 96105, consult the following resources:

• AMA CPT Codebook – Provides code details and billing guidance
• Medicare fee schedule – Lists Medicare fees by location and MAC
• Payer coverage policies – Outline tests covered and preauthorization needs
• ASHA and state associations – Offer regular billing and coding updates
• Online CPT lookup tools – Enable easy access to code details

With the right resources and understanding of guidelines, SLPs can optimize their use of CPT code 96105 to be reimbursed for assessment of speech, language and cognitive deficits.

Conclusion

CPT code 96105 provides speech-language pathologists with an effective billing mechanism for assessments of patients with aphasia and neurocognitive disorders. Key steps for accurate billing include:

• Documenting medical need for skilled testing
• Tracking precise time increments spent assessing the patient
• Selecting the accurate ICD-10 diagnosis code
• Verifying payer coverage specifics and fees
• Consulting AMA and SLP resources to avoid errors

Following coding guidelines for 96105 allows SLPs to provide comprehensive assessments and receive proper reimbursement to support their services.