Or. Admin. Code § 410-129-0200

Current through Register Vol. 63, No. 12, December 1, 2024

Section 410-129-0200 - Speech-Language Pathology Procedure Codes

(1) Inclusion of a current procedural terminology (CPT) or healthcare common procedure coding system (HCPCS) code in sections (2), (3) and (4) does not mean a code is covered. Refer to OAR 410-141-0480, 410-141-0500, and 410-141-0520 for information on coverage.

(2) The following Speech therapy services are subject to PPR when paired above the funding line on the HERC prioritized list (see OAR 410-141-0520), when visits have not exceeded the allowed 30 habilitative and 30 rehabilitative visits allowed in a calendar year:

(a) 92507 Treatment of speech, language, voice, communication and auditory processing disorder, individual; and

(b) 92508 Group, two or more individuals.

(3) PA is required for SLP services:

(a) When there is documented need for extended service, considering 60 minutes as the maximum length of a treatment session;

(b) When there is documented need for continuing rehabilitative or habilitative therapy, considering 30 habilitative and 30 rehabilitative visits in a calendar year;

(c) When requesting services for treatments that are below the funded line or not otherwise excluded from coverage per OAR 410-141-0480;

(d) For the following services:

(A) E2500 Speech generating device, digitized speech, using prerecorded messages, less than or equal to eight minutes recording time;

(B) E2502 Speech generating device, digitized speech, using prerecorded messages, greater than eight minutes but less than 20 minutes;

(C) E2504 Speech generating device, digitized speech, using prerecorded messages, greater than 20 minutes but less than 40 minutes;

(D) E2506 Speech generating device, digitized speech, using prerecorded messages, greater than 40 minutes recording time;

(E) E2508 Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device;

(F) E2510 Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access;

(G) E2511 Speech generating software program for personal computer or personal digital assistance;

(H) E2512 Accessory for speech generating device, mounting system;

(I) E2599 Accessory for speech generating device, not otherwise classified;

(J) L7520 Repair prosthetic device, labor component, for 15 minutes;

(K) L8510 Voice amplifier; and

(L) V5336 Repair, modification of augmentative communication system or device excluding adaptive hearing aid.

(4) Services not subject to PPR or PA:

(a) 92521 Evaluation of speech fluency (e.g., stuttering, cluttering);

(b) 92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);

(c) 92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) with evaluation of language comprehension and expression (e.g., receptive and expressive language);

(d) 92524 Behavioral and qualitative analysis of voice and resonance;

(e) 92597 Evaluation for use and fitting of voice prosthetic device to supplement oral speech;

(f) 92607 Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient, first hour;

(g) 92610 Evaluation of oral and pharyngeal swallowing function, limited to two per 12-month period;

(h) 92608 Each additional 30 minutes (List separately in addition to code for primary procedure);

(i) 92611 Motion fluoroscopic evaluation of swallowing function by cine or video recording, limited to two per 12-month period;

(j) S9152 Speech therapy, re-evaluation, limited to four per 12-month period;

(k) A4649 Supplies for speech therapy, limited to two per calendar year not to exceed $4.75 each;

(l) 92526 Treatment of swallowing dysfunction and oral function for feeding;

(m) 92609 Therapeutic services for the use of speech-generating device, including programming and modification;

(n) L7510 Repair of prosthetic device, repair or replace minor parts;

(o) L8500 Artificial larynx, any type;

(p) L8501 Tracheostomy speaking valve;

(q) L8507 Tracheoesophageal voice prosthesis, patient inserted, any type, each;

(r) L8509 Tracheoesophageal voice prosthesis, inserted by a licensed health provider, any type;

(s) L8515 Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each; and

(t) L9900 Orthotic and prosthetic supply necessary or service component of another HCPCS L code (PA required).

Or. Admin. Code § 410-129-0200

HR 5-1991, f. 1-18-91, cert. ef. 2-1-91; HR 11-1992, f. & cert. ef. 4-1-92; HR 27-1993, f. & cert. ef. 10-1-93; HR 36-1994, f. 12-30-94, cert. ef. 1-1-95; OMAP 36-1999, f. & cert. ef. 10-1-99; OMAP 6-2000, f. 3-31-00, cert. ef. 4-1-00; OMAP 20-2001, f. 3-30-01, cert. ef. 4-1-01; OMAP 10-2002, f. & cert. ef. 4-1-02; OMAP 22-2003, f. 3-26-03, cert. ef. 4-1-03; OMAP 12-2004, f. 3-11-04, cert. ef. 4-1-04; OMAP 14-2005, f. 3-11-05, cert. ef. 4-1-05; OMAP 18-2006, f. 6-12-06, cert. ef. 7-1-06; DMAP 17-2007, f. 12-5-07, cert. ef. 1-1-08; DMAP 100-2018, amend filed 11/06/2018, effective 11/06/2018; DMAP 102-2018, amend filed 12/13/2018, effective 12/13/2018; DMAP 18-2019, temporary amend filed 06/18/2019, effective 7/1/2019 through 12/27/2019; DMAP 44-2019, amend filed 11/06/2019, effective 11/14/2019

Tables referenced are available from the agency.

Statutory/Other Authority: ORS 413.042

Statutes/Other Implemented: ORS 414.025 & ORS 414.065