1. Chapter 538 School-Based Health Services
Speech Therapy Billing Form
Effective August 1, 2019

2. Consent to Bill Medicaid
Prior to billing parents must provide written consent to release information and to bill for Medicaid reimbursement.
Consent is valid for one calendar year from the signature date.
Parents are to be provided an annual notice.

3. Plan of Care
Services must be documented on the Plan of Care signed by the parent and therapist.
Effective August 1, 2019 Service Care Plan is now called a Plan of Care. This provides more consistency and avoids a terminology conflict with private school service plans. There is not a need to have a new one signed if it says Service Care Plan and is still current.
The Online IEP Program has been adjusted to reflect the change in terminology.
Specific ICD-10 diagnosis codes are required. ICD-10 codes must relate to the specific type of therapy being provided. Think of these more as treatment diagnosis codes. All appropriate diagnosis codes need to be listed on the Plan of Care.
A global code such as Autism would not be appropriate.

4. Physician Authorization Form
Physician Authorization (PAF) is required annually to bill for speech therapy.
The Speech Therapist is to document suggested ICD-10 diagnosis codes that specifically relate to the therapy being provided.
When the physician signs the authorization form they are confirming the therapist’s code(s).
Authorizations can be signed by a Physician (MD or DO), Physician’s Assistant (PA) or by an Advanced Practice Registered Nurse (APRN).
Should still obtain PAF even if the student will be working with an SSLPA.

5. Student Demographics Use the student’s real name as listed in WVEIS
The diagnosis code is to be an ICD-10 code that matches the need for speech therapy.
County and school names can be written out or use the county and school WVEIS codes.
For provider name print the name of the person providing the service.

6. Service Record – School Based Speech Therapy Billing Form
Medicaid Number
Last Name
First Name
WVEIS Number
Date of Birth
Provider Name
County
School
Month/Year

7. Service Record – School Based Speech Therapy Billing Form
Medicaid Number
Last Name
First Name  
Doe
Aubrey
WVEIS Number
Date of Birth
Provider Name
Suzanne Smith
County
School
Month/Year
59 
501
Sept/2019

8. Diagnosis Codes
Enter the Speech/Language specific ICD 10 Diagnosis Codes on the form starting with box number one.
Enter the codes that are directly associated with the therapy sessions and/or assessments.

9. LIST ALL DIAGNOSIS CODES RELATED TO SPEECH THERAPY
ICD 10 Diagnosis Codes
LIST ALL DIAGNOSIS CODES RELATED TO SPEECH THERAPY 1. 2. 3. 4. 5. 6.

10. LIST ALL DIAGNOSIS CODES RELATED TO SPEECH THERAPY
ICD 10 Diagnosis Codes
LIST ALL DIAGNOSIS CODES RELATED TO SPEECH THERAPY 1.
F80.0 2.
F80.2 3.
F80.81 4.
F80.82 5. 6.

11. Speech Therapy Procedure Codes
Service Unit
92507
Treatment of speech language, voice, communication, and/or auditory processing disorder (includes aural rehabilitation); Individual therapy session
24 units per month at 15 minutes per unit
92508
Treatment of speech language, voice, communication, and/or auditory processing disorder (includes aural rehabilitation); Group, two or more individuals
24 units per month at 15 minutes per unit
92521
Evaluation of speech fluency (e.g., stuttering, cluttering)
1 per calendar year
92522*
Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria)
92523*
Evaluation of speech production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524
Behavioral and qualitative analysis of voice and resonance
92567
Tympanometry (impedance testing) Can also be performed by RN
92570
Acoustic Immitance Testing Can also be performed by RN
4 per calendar year
92583
Select Picture Audiometry
92592
Hearing Aid Check - Monaural
92593
Hearing Aid Check-Binaural
Notes: *92522 and may not be billed together on the same day. A speech sound production evaluation (92522) is already included as a part of (speech sound production evaluation with language evaluation). If a service is provided via Telehealth add GT modifier to the procedure code.

12. Procedure Code Changes
The following is no longer a valid CPT code for billing school-based services in West Virginia.
92561 – Bekesy Diagnostic
The maximum units of services per month increased from 16 to 24 units for the following CPT codes:
92507 – Individual therapy
92508 – Group therapy

13. Enter Claim Documentation
Use the CPT codes and caps from slide eleven to complete the claim documentation section of the billing form.
In the first column list the service date. (If combining minutes from different days for a unit use the date the 15th minute occurred to complete the unit. No span dates are allowed.)
Column two - enter one or more of the diagnosis code numbers that directly relates to the services. (examples 1, 1 & 3, 2)
Column three - enter the CPT code including a GT modifier if being provided by telehealth.
Columns four and five - enter the start and end time.
In the last column enter the total number of units or event(s).

14. List Diagnosis Code Number(s)
Claim Documentation
Service Date
List Diagnosis Code Number(s)
Procedure code
Start Time
End Time
Units/Event

15. List Diagnosis Code Number(s)
Claim Documentation
Service Date
List Diagnosis Code Number(s)
Procedure code
Start Time
End Time
Units/Event 1
92507
9:00
9:10 0*  
9:00  1* 3 
92508
10:31
11:01 2    
 2,4
1:00
1:40  
 1,2,3,4
92521 
8:30
10:15
*Indicates how to document your sessions without a 15 minute unit and bill the unit the day you have the combined 15 minutes.

16. Third Party Billing
At times a student may be eligible for Medicaid as the secondary insurance.
Medicaid is the payer of last resort for direct services (OT, PT, Speech, Audiology, Psychological, and Nursing).
If the student has special transportation services, the direct billing should be submitted. The claim will be denied but will justify claiming transportation billing for that instructional day.
Medicaid will pay ancillary services (TCM, personal care aide and special transportation) as the secondary insurance.
Occasionally a student may be eligible for Medicaid under two numbers. In this case district’s should always use the primary Medicaid number.

17. School Speech-Language Pathologist Assistant (SSLPA)
To bill under BMS policy the speech-language pathologist has to be fully licensed by the West Virginia Board of Examiners for Speech- Language Pathology and Audiology (WVBESLPA).
According to BMS policy a WVDE certified speech-language pathologist is considered an SSLPA.
SLPAs and speech-language pathologists in the CFY year even if licensed by the WVSESLPA are considered SSLPA by BMS policy.
SSLPAs are still to complete the billing paperwork process. However, districts will not submit for direct billing purposes.
SSLPAs can and should submit Targeted Case Management (TCM) billing.

18. Signature and Credentials
_____________________ ______________ Signature/Credentials Date

19. Signature and Credentials
__Suzanne Smith___ SLP___ October 1, 2019 Signature/Credentials Date

20. Additional Documentation
Progress/therapy logs will also be required.
Original copies of progress/therapy logs must be on file in the special education central office. Please keep a copy of your notes for your personal records.
Lee Ann Brammer in conjunction with BMS has developed a form which can be used to complete the required documentation. It is available on the WVDE website. It is not a mandatory form.
There is not a required form for documentation of progress/therapy logs, however, all of the SOAP (Subjective, Objective, Assessment, and Plan) Note components must be included in the log.

21. Kelley Johnson – Coordinator Office of Special Education kelley
Kelley Johnson – Coordinator Office of Special Education ext WVDE Medicaid Website: