Evaluation and Management Codes Not Payable to Audiology and Speech Language Pathology Specialties

Date Issued: 8/19/2010

(For HIP and CompreHealth)

Please be reminded that guidelines from the Centers for Medicare and Medicaid Services (CMS) have determined that CPT codes for Evaluation and Management (E/M) services are not payable to audiology and speech-language pathology specialists, including audiologists and speech therapists. As outlined in your Agreement(s), HIP adheres to CMS guidelines for its reimbursement methodology. The following E/M codes will be denied if claims are submitted by audiology or speech-language pathology specialists: 99201-99205 99211-99215 99241-99245

CMS guidelines and the rules for which CPT codes audiology and speech-language pathology specialists may use can be found on the American Speech-Language-Hearing Association’s Web site. Please consult your Agreement or speak with your Provider Relations Representative to determine what codes are covered by HIP.