Selecting an Appropriate CPT Code: When Multiple Codes Apply

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Selecting the correct CPT code to describe a service provided is guided by several general principles: (1) Any code in the CPT manual can be used by any professional, as long as it is within their scope of practice; (2) That said, certain payors (like Medicare) can decide they won't reimburse for a specific code; (3) sometimes two codes may equally accurately describe the service rendered.

If a payor has said it won't pay for a specific service, then the clinician can see if another code (that is reimbursed) still accurately describes what was done. Many Medicare Fiscal Intermediaries (FIs) have said SLPs can't use the Cognitive Retraining Code (97532). Medicare has also indicated it considers 92507 as an "umbrella" code that covers everything SLPs do.

To answer your specific question, I think your interpretation of the difference in cognitive retraining vs. speech-language treatment is exactly how I would interpret it. You can find out if your Medicare FI will pay for SLPs performing cognitive retraining by reading the Local Coverage Determination (LCD). Your facilities should have copies of these documents. If your FI will not pay SLPs to perform cognitive therapy, then 92507 is an accurate choice as well.

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Nancy Swigert, M.A., CCC/SLP, BRS-S is the Director of Speech-Language Pathology and Respiratory Care at Central Baptist Hospital in Lexington, KY. She is also Chair of the ASHA Health Care Economics Committee.