OAR 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).