CPT code 92605 is used for evaluating a patient's use of a nonspeech device, aiding in communication assessments and therapy planning.
CPT code 92605 is used to describe the evaluation for prescription of non-speech-generating devices. This code is typically utilized by healthcare professionals when assessing a patient's need for alternative communication devices that do not produce speech. The evaluation involves determining the most appropriate device to assist the patient in communication, considering factors such as the patient's specific needs, abilities, and the potential effectiveness of the device. This code is crucial for ensuring that patients receive the right tools to aid in their communication, enhancing their ability to interact and engage with others.
For CPT code 92605, which pertains to the evaluation for nonspeech-generating device prescription, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the evaluation required significantly more time or effort than typically required. Documentation should support the additional work.
2. Modifier 52 (Reduced Services): Apply this modifier if the evaluation was partially completed or if the service was reduced at the request of the patient or due to unforeseen circumstances.
3. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): Use this modifier if the evaluation needs to be repeated on the same day by the same provider due to medical necessity.
4. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): This modifier is applicable if the evaluation is repeated on the same day by a different provider.
5. Modifier 59 (Distinct Procedural Service): Use this modifier to indicate that the evaluation was distinct or independent from other services performed on the same day. This is particularly relevant if multiple evaluations or procedures are conducted.
6. Modifier 95 (Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System): If the evaluation is conducted via telemedicine, this modifier should be used to indicate the service was provided through a real-time interactive audio and video system.
7. Modifier GT (Via Interactive Audio and Video Telecommunications Systems): Similar to Modifier 95, this modifier is used for telehealth services, indicating the evaluation was conducted through interactive audio and video telecommunications.
Each modifier should be used in accordance with payer guidelines and supported by appropriate documentation to justify its application.
CPT code 92605 is associated with the evaluation for nonspeech-generating device prescriptions. Whether this code is reimbursed by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the specific Medicare Administrative Contractor (MAC) that processes claims in your region.
To determine if CPT code 92605 is reimbursed by Medicare, healthcare providers should first consult the MPFS, which lists the services covered by Medicare and their corresponding reimbursement rates. If 92605 is listed in the MPFS, it indicates that Medicare may reimburse for this service, subject to meeting specific coverage criteria.
Additionally, it is crucial to review the local coverage determinations (LCDs) and national coverage determinations (NCDs) provided by the MAC responsible for your area. MACs have the authority to establish specific guidelines and requirements for reimbursement, which can vary by region. Therefore, checking with your MAC will provide the most accurate and up-to-date information regarding the reimbursement status of CPT code 92605 under Medicare.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 92605. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you’re receiving the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
