All temporary policy flexibilities outlined in COVID-19 Special Bulletins remain in effect as of this publication date. See COVID-19 Special Bulletins for details.
An amended version of Clinical Coverage Policy 10C, Outpatient Specialized Therapies, Local Education Agencies (LEAs) with an effective date of June 15, 2021, was posted to the NC Medicaid Clinical Coverage Policy web page. Following is a summary of updates:
In Subsection 3.5, Speech-Language Therapy, the following medical necessity guidance was added:
c. Telehealth
A select set of speech and language evaluation and treatment interventions may be billed by LEAs when provided to student beneficiaries using a telehealth delivery method as described in Clinical Coverage Policy 1-H. Telehealth delivery may be medically necessary when a student is medically homebound, during an extended school closure, or if their school is remote or underserved such that access to appropriately qualified providers is limited.
Note: CPT codes that may be billed when service is furnished via telehealth are indicated in Attachment A, Section C: Codes.
In Attachment A, Claims-Related Information, Section C: Codes, the following CPT codes were identified as telehealth eligible services:
|
CPT code |
Short Description |
|
92521 |
Evaluation of speech fluency (e.g., stuttering, cluttering) |
|
92522 |
Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) |
|
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) |
|
92524 |
Behavioral and qualitative analysis of voice and resonance |
|
92607 |
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour |
|
92608 |
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes |
|
92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual |
|
92526 (oral motor only) |
Treatment of swallowing dysfunction and/or oral function for feeding |
|
92609 |
Therapeutic services for the use of speech-generating device, including programming and modification |
Additional Resources
The full text of Clinical Coverage Policy 10C, Outpatient Specialized Therapies, Local Education Agencies (LEAs) is available at North Carolina Medicaid’s Outpatient Specialized Therapy Services web page. All COVID-19 Special Bulletins are available here.
Contact
NC Medicaid Contact Center, 888-245-0179