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    v1.0.28
    OpenPayerBilling CodesProcedures / Professional ServicesHCPCS hcpcs-g0153-speech-language-pathology-home-health-hospice
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    HCPCS G0153: Speech-Language Pathology in Home Health or Hospice

    HCPCS Level II code G0153 describes services provided by a qualified speech‑language pathologist in the home health or hospice setting, billed in 15‑minute increments for direct speech‑language pathology treatment and therapeutic intervention delivered in the patient’s residence or hospice location.

    For related coverage guidance, see recent payer policy updates: Esophagogastroduodenoscopy (EGD) Coverage Policy, Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD), Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease.

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    National Reimbursement Benchmarks

    National commercial rates for HCPCS G0153 cluster around the BUCA average commercial rate of $72.50, with payers showing distinct central tendencies and extremes. Blue Cross Blue Shield centers much higher (median $97.90) and Aetna is tightly bunched around the mid-$20s (median $24.00). Cigna sits near the lower-middle range (median $59.00), while UnitedHealth Group displays a median of $0 but a high P90 of $45.50, indicating many zero-value observations alongside some positive outliers.

    Rate dispersion (P75 minus P25) highlights contrasting variability: Blue Cross Blue Shield’s interquartile range is $13.50 (P75 $103.50 minus P25 $94.00), indicating moderate spread; BUCA’s IQR is $5.50 (P75 $71.10 minus P25 $65.60), the tightest among listed payers; Cigna’s IQR is $0.70 (P75 $59.70 minus P25 $59.00), also very tight; Aetna’s IQR is $0.00 (P75 $24.00 minus P25 $24.00), the least dispersed. UnitedHealth Group shows the widest effective dispersion given P25 $0.00 and P75 $0.00 (IQR $0.00) combined with a large gap between median and P90, signaling concentration at zero with some high-end variation.

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    State Reimbursement Rates

    State: Alaska1 / 51

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    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old homebound patient with recent ischemic stroke presents to home health services with persistent oropharyngeal dysphagia and expressive speech impairment. The patient has a history of right-sided hemiparesis and difficulty safely managing thin liquids, resulting in multiple coughing episodes during meals. A qualified speech-language pathologist (SLP) from the home health agency conducts skilled, face-to-face treatment sessions in the patient’s residence. Each treatment session addresses swallowing exercises, compensatory strategies (chin-tuck, diet modifications), caregiver training for safe feeding techniques, and direct speech-language therapy for articulation and functional communication. Documentation includes time-based tracking in 15-minute units, objective pre- and post-session measures (eg, swallow safety, cough frequency, diet level), patient response, skilled interventions provided, and plan for subsequent visits. Homebound status and medical necessity for skilled SLP services are documented in the home health plan of care. The typical workflow: referral and physician orders → initial home evaluation (including baseline swallowing and communication assessment) → establishment of treatment goals → skilled treatment visits billed per 15-minute unit using G0153 → periodic skilled re-evaluation and coordination with the interdisciplinary team.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    G0161Services performed by a qualified speech‑language pathologist in the home health setting, in the establishment or delivery of a safe and effective speech‑language pathology maintenance program, each 15 minutes.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    235Z00000XSpeech-Language PathologistThe speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in…
    251E00000XHome Health AgencyA public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing se…
    253Z00000XIn Home Supportive Care AgencyAn In Home Supportive Care Agency provides services in the patient's home with the goal of enabling the patient to remain at home. The services provi…
    202C00000XIndependent Medical Examiner PhysicianA special evaluator not involved with the medical care of the individual examinee that impartially evaluates the care being provided by other practiti…
    261QR0404XCardiac Rehabilitation Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    261QI0500XInfusion Therapy Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    207RI0011XInterventional Cardiology PhysicianAn area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and p…
    313M00000XNursing Facility/Intermediate Care FacilityAn institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related …

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01
    Celiac Disease TestingOscar Health2026-10-01
    Laboratory Testing for the Diagnosis of Inflammatory Bowel DiseaseOscar Health2026-10-01
    Percutaneous Electrical Nerve Field Stimulation (PENFS)Cigna2026-09-15
    Colorectal Cancer ScreeningBlue Cross Blue Shield - New Mexico2026-09-04

    Related Codes

    HCPCS-G9490-HOME-ASSESSMENT-NON-HOMEBOUND

    HCPCS G9490: Home Visit Patient Assessment for Non-Homebound Beneficiary

    HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

    HCPCS G0008: Administration of Influenza Virus Vaccine

    HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

    HCPCS G0009: Administration of Pneumococcal Vaccine

    HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

    HCPCS G0010: Administration of Hepatitis B Vaccine

    HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

    HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

    HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

    HCPCS G0012: Injection of PrEP Drug for HIV Prevention

    HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

    HCPCS G0013: Individual PrEP Counseling by Clinical Staff

    HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

    HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

    HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

    HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

    HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

    HCPCS G0019: Community Health Integration, Person-Centered Assessment

    Showing 1–10 of 1996

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Used for SLP maintenance program services in home health; complements G0153 when establishing or delivering a maintenance plan.
    92507Speech/hearing treatment; direct (eg, articulation, language, voice, etc.)Alternative outpatient direct treatment code; may be used for non-home-based therapy or as re-evaluation alternative in some workflows.
    92607Evaluation for prescription for speech generating device; selection, fitting and training.Used when SLP evaluates and prescribes an augmentative and alternative communication device as part of home care.
    92609Evaluation for prescription for speech generating device; adaptation of devices and training.Used for device adaptation and training following initial device selection in the home setting.
    92597Evaluation for use and/or effect of speech‑generating deviceUsed to evaluate effectiveness of an existing speech-generating device during home visits; may precede or follow G0153 therapy sessions.