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CO HCPF Speech Therapy Billing Manual — National Correct Coding Initiative (NCCI)

NationalCorrectCodingInitiative(NCCI)

activein force · 2026-07-26 – presentas-observed

NationalCorrectCodingInitiativeProcedure-To-Procedure(PTP)andMedicallyUnlikelyEdits(MUE)editsapplytocertaincombinationsofspeechtherapyprocedurecodes.VisittheNationalCorrectCodingInitiativeinMedicaidwebpageontheCMSwebsitewitheditsfortheNCCIPolicyManual,acompletelistofimpactedcodes,guidanceonbypassmodifierusesandgeneralinformation.

PolicyguidanceforNCCIprovidedinthismanualdoesnotsupersedeFederalNCCIpolicy.ItispublishedtoassistprovidersinunderstandinghowtheHealthFirstColoradoSpeechTherapybenefitisaffectedbyNCCIeditsandpolicy.

Althougheveryeffortismadetoguideprovidersaccordingly,thismanualmaynotalwaysreflectthemostuptodateNCCIpolicies,norisitanexhaustivelistofanyedit/policythatmayaffectthespeechtherapybenefit.ProvidersshouldalwaysreferencetheMedicaidwebsiteforthemostcurrentNCCIpoliciesasthosepoliciesmaychange.

HealthFirstColoradodoesnotcreateNCCIpolicy.

AllprovidersarerequiredtocomplywithNCCIpolicy.

PursuanttotheNCCIPolicyManual(CurrentRevision1-1-2026,ChapterXI):

SpeechlanguagepathologistsshallnotreportHCPCS/CPTcodes97110,97112,97150,97530,97127orG0515asunbundledservicesincludedintheservicescodedas92507,92508,or92526.(CPTcode97532wasdeletedonJanuary1,2018.)

AsinglepractitionershouldnotreportCPTcodes92507(treatmentofspeech,language,voice...,individual)and/or92508(treatmentofspeech,language,voice...,group)onthesamedateofserviceasHCPCS/CPTcodes97127(therapeuticinterventionsthatfocusoncognitivefunction...),or97533(sensoryintegrativetechniquestoenhance...),orG0515(developmentofcognitiveskillstoimprove...).

However,ifthetwotypesofservicesareperformedbydifferenttypesofpractitionersonthesamedateofservice,theymaybereportedseparatelybyasinglebillingentity.Forexample,ifaspeechlanguagepathologistperformstheproceduresdescribedbyCPTcodes92507and/or92508onthesamedateofservicethatanoccupationaltherapistperformstheproceduresdescribedbyHCPCS/CPTcodes97127,97533and/orG0515,aproviderentitythatemploysbothtypesofpractitionersmayreportbothservicesutilizinganNCCIPTP-associatedmodifier.(CPTcode97532wasdeletedonJanuary1,2018.)

Treatmentofswallowingdysfunctionand/ororalfunctionforfeeding(CPTcode92526)mayutilizeelectricalstimulation.TheHCPCScodeG0283(electricalstimulation(unattended),tooneormoreareasforindication(s)otherthanwoundcare...)shouldnotbereportedwithCPTcode92526forelectricalstimulationduringtheprocedure.TheNCCIPTPedit(92526/G0283)forpractitionerserviceclaimsdoesnotallowuseofNCCIPTP-associatedmodifierswiththiseditbecausethesameproviderwouldneverperformbothoftheseservicesonthesamedateofservice.However,thesameeditforoutpatienthospitalfacilityclaimsdoesallowuseofNCCIPTP-associatedmodifiersbecausetwoseparatepractitionersinthesameoutpatienthospitalfacilityorinstitutionaltherapyprovidermightperformthetwoproceduresfordifferentpurposesatdifferentmemberencountersonthesamedateofservice.

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Provenance

Source: hcpf.colorado.gov
Retrieved: 2026-07-26
Edition: 2026-07-26
Content hash: afbbda81134eebd9512fb435201ee9874411c5d4c7b94923611708d0e6a2981e

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