Services Not Reimbursable to Speech-Language Therapists/Pathologists
Defines CPT/other codes that UnitedHealthcare will not reimburse when billed by Speech-Language Therapists/Pathologists on the CMS-1500 form; applies to UnitedHealthcare Commercial and Individual Exchange plans and all providers billing those products.
No material clinical or coverage changes in this revision.
Services Not Reimbursable When Reported by Speech-Language Therapists/Pathologists
Non-reimbursable services reported by Speech-Language Therapists/Pathologists
UnitedHealthcare will not reimburse specific CPT and other codes when reported by Speech‑Language Therapists/Pathologists; see the attached code list for details.
Codes and Attachments — Not Reimbursable
| List of CPT codes from Physical Medicine and Rehabilitation, Evaluation and Management, Adaptive Behavior Assessment and other sections that will not be reimbursed when reported by Speech-Language Therapists/Pathologists (see attachment). |
Billing and Modifier Guidance for Speech-Language Pathology Services
Use HCPCS modifier GN for outpatient speech‑language therapy
Submit speech therapy service codes with HCPCS modifier GN when the services are delivered under an outpatient speech‑language pathology plan of care; GN should be used with any speech therapy service codes provided by a Speech‑Language Pathologist that CMS considers “always therapy.” The GN modifier does not permit a Speech‑Language Therapist/Pathologist to bill for services they are not qualified or recognized to perform.
- Apply HCPCS modifier GN to speech therapy service codes delivered under an outpatient speech‑language pathology plan of care.
- Use GN with speech therapy codes that CMS designates as “always therapy.”
- Do not use GN to justify billing for services outside the provider’s recognized scope or qualifications.
Scope and Definition of Speech-Language Pathology Services
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