Medicare Billing Update

Abstract

Abstract As of July 2009, speech-language pathologists (SLPs) may bill for Medicare services as private practitioners. This article directs SLPs to the rules for enrollment, necessary approvals by physicians and certain physician substitutes, and proper current procedural terminology (CPT) and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) coding when submitting claims. Guidance for determination of the exact payment amount for specific geographic areas is covered as well as determination of local Medicare Administrative Contractor (MAC) Web sites and their local coverage policies for speech-language-voice and dysphagia services. Special rules apply to SLPs who are employees or contractors of physician groups, and these SLPs also may function as private practitioners in physician office settings if they follow certain rules that insulate SLPs from kickback accusations. The rules governing these SLPs are summarized in this article. Questions regarding reimbursement should be directed to the Division 3 Reimbursement Committee or to Reimbursement@asha.org .