1. (1) Inclusion of a current procedural terminology (CPT) or healthcare common procedure coding system (HCPCS) code in sections (2), (3) and (4) does not mean a code is covered. Refer to OAR 410-141-0480, 410-141-0500, and 410-141-0520 for information on coverage.

2. (2) The following Speech therapy services are subject to PPR when paired above the funding line on the HERC prioritized list (see OAR 410-141-0520), when visits have not exceeded the allowed 30 habilitative and 30 rehabilitative visits allowed in a calendar year:

   1. (a) 92507 Treatment of speech, language, voice, communication and auditory processing disorder, individual; and
   2. (b) 92508 Group, two or more individuals.

3. (3) PA is required for SLP services:

   1. (a) When there is documented need for extended service, considering 60 minutes as the maximum length of a treatment session;
   2. (b) When there is documented need for continuing rehabilitative or habilitative therapy, considering 30 habilitative and 30 rehabilitative visits in a calendar year;
   3. (c) When requesting services for treatments that are below the funded line or not otherwise excluded from coverage per OAR 410-141-0480;

   4. (d) For the following services:

      1. (A) E2500 Speech generating device, digitized speech, using prerecorded messages, less than or equal to eight minutes recording time;
      2. (B) E2502 Speech generating device, digitized speech, using prerecorded messages, greater than eight minutes but less than 20 minutes;
      3. (C) E2504 Speech generating device, digitized speech, using prerecorded messages, greater than 20 minutes but less than 40 minutes;
      4. (D) E2506 Speech generating device, digitized speech, using prerecorded messages, greater than 40 minutes recording time;
      5. (E) E2508 Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device;
      6. (F) E2510 Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access;
      7. (G) E2511 Speech generating software program for personal computer or personal digital assistance;
      8. (H) E2512 Accessory for speech generating device, mounting system;
      9. (I) E2599 Accessory for speech generating device, not otherwise classified;
      10. (J) L7520 Repair prosthetic device, labor component, for 15 minutes;
      11. (K) L8510 Voice amplifier; and
      12. (L) V5336 Repair, modification of augmentative communication system or device excluding adaptive hearing aid.

4. (4) Services not subject to PPR or PA:

   1. (a) 92521 Evaluation of speech fluency (e.g., stuttering, cluttering);
   2. (b) 92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
   3. (c) 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);
   4. (d) 92524 Behavioral and qualitative analysis of voice and resonance;
   5. (e) 92597 Evaluation for use and fitting of voice prosthetic device to supplement oral speech;
   6. (f) 92607 Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient, first hour;
   7. (g) 92610 Evaluation of oral and pharyngeal swallowing function, limited to two per 12-month period;
   8. (h) 92608 Each additional 30 minutes (List separately in addition to code for primary procedure);
   9. (i) 92611 Motion fluoroscopic evaluation of swallowing function by cine or video recording, limited to two per 12-month period;
   10. (j) S9152 Speech therapy, re-evaluation, limited to four per 12-month period;

   11. (k) A4649 Supplies for speech therapy, limited to two per calendar year not to exceed $4.75 each;

       1. (L) 92526 Treatment of swallowing dysfunction and oral function for feeding;
   12. (m) 92609 Therapeutic services for the use of speech-generating device, including programming and modification;
   13. (n) L7510 Repair of prosthetic device, repair or replace minor parts;
   14. (o) L8500 Artificial larynx, any type;
   15. (p) L8501 Tracheostomy speaking valve;
   16. (q) L8507 Tracheoesophageal voice prosthesis, patient inserted, any type, each;
   17. (r) L8509 Tracheoesophageal voice prosthesis, inserted by a licensed health provider, any type;
   18. (s) L8515 Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each; and
   19. (t) L9900 Orthotic and prosthetic supply necessary or service component of another HCPCS L code (PA required).

Statutory/Other Authority

ORS 413.042

Statutes/Other Implemented

ORS 414.025 & ORS 414.065

History

DMAP 44-2019, amend filed 11/06/2019, effective 11/14/2019
DMAP 18-2019, temporary amend filed 06/18/2019, effective 07/01/2019 through 12/27/2019
DMAP 102-2018, amend filed 12/13/2018, effective 12/13/2018
DMAP 100-2018, amend filed 11/06/2018, effective 11/06/2018
DMAP 17-2007, f. 12-5-07, cert. ef. 1-1-08
OMAP 18-2006, f. 6-12-06, cert. ef. 7-1-06
OMAP 14-2005, f. 3-11-05, cert. ef. 4-1-05
OMAP 12-2004, f. 3-11-04, cert. ef. 4-1-04
OMAP 22-2003, f. 3-26-03, cert. ef. 4-1-03
OMAP 10-2002, f. & cert. ef. 4-1-02
OMAP 20-2001, f. 3-30-01, cert. ef. 4-1-01
OMAP 6-2000, f. 3-31-00, cert. ef. 4-1-00
OMAP 36-1999, f. & cert. ef. 10-1-99
HR 36-1994, f. 12-30-94, cert. ef. 1-1-95
HR 27-1993, f. & cert. ef. 10-1-93
HR 11-1992, f. & cert. ef. 4-1-92
HR 5-1991, f. 1-18-91, cert. ef. 2-1-91