How To Use CPT Code 96105

CPT 96105 describes the assessment of aphasia, including the evaluation of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, and writing. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 96105?

CPT 96105 can be used to describe the assessment of aphasia, a condition that affects a patient’s ability to understand or use words. This code is used when a provider, such as a physician or licensed speech pathologist, evaluates the patient’s expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, and writing. The assessment is typically performed using the Boston Diagnostic Aphasia Examination, which assesses various language problems and communication abilities.

2. Official Description

The official description of CPT code 96105 is: ‘Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, eg, by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour.’

3. Procedure

1. The provider evaluates the patient for aphasia, a disorder that affects the patient’s ability to understand or use words.
2. The assessment includes the evaluation of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, and writing.
3. The Boston Diagnostic Aphasia Examination is typically used to assess the patient’s language problems and communication abilities.
4. The provider administers the test, scores the test, interprets the findings, formulates a diagnosis, and develops treatment guidelines.
5. The assessment is performed for a duration of one hour.

4. Qualifying circumstances

Patients eligible to receive CPT 96105 services are those with aphasia, a condition that affects their ability to understand or use words. This condition is most commonly caused by a stroke or brain injury. The assessment is typically performed by a provider who is qualified to evaluate and diagnose aphasia, such as a physician or licensed speech pathologist. The Boston Diagnostic Aphasia Examination is used to assess the patient’s expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, and writing.

5. When to use CPT code 96105

CPT code 96105 should be used when a provider performs an assessment of aphasia, including the evaluation of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, and writing. This code is appropriate for a one-hour assessment session. It should not be used for other types of evaluations or assessments.

6. Documentation requirements

To support a claim for CPT 96105, the provider must document the following information:

• Patient’s diagnosis of aphasia
• Specific tests and assessments performed, including the Boston Diagnostic Aphasia Examination
• Date and duration of the assessment session
• Interpretation of the findings
• Formulated diagnosis
• Development of treatment guidelines
• Signature of the provider performing the assessment

7. Billing guidelines

When billing for CPT 96105, ensure that the assessment is performed by a qualified provider, such as a physician or licensed speech pathologist. The assessment should include the evaluation of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, and writing. CPT code 96105 should not be reported with other codes unless additional services are provided that are distinct and separate from the assessment of aphasia.

8. Historical information

CPT 96105 was added to the Current Procedural Terminology system on January 1, 1996. There have been no updates to the code since its addition.

9. Examples

1. A licensed speech pathologist performing an assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, and writing for a patient with aphasia.
2. A physician evaluating a patient’s ability to understand and use words, including their expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, and writing, using the Boston Diagnostic Aphasia Examination.
3. A licensed speech pathologist assessing a patient’s language problems and communication abilities, including expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, and writing, during a one-hour session.
4. A provider using the Boston Diagnostic Aphasia Examination to evaluate a patient’s expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, and writing, and interpreting the findings to formulate a diagnosis and develop treatment guidelines.
5. A licensed speech pathologist performing an assessment of aphasia, including the evaluation of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, and writing, and providing an interpretation and report of the results.
6. A physician evaluating a patient’s ability to communicate, including their expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, and writing, using the Boston Diagnostic Aphasia Examination and documenting the findings in a report.
7. A licensed speech pathologist assessing a patient’s language skills, including expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, and writing, and providing an interpretation and report of the assessment results.
8. A provider using the Boston Diagnostic Aphasia Examination to evaluate a patient’s expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, and writing, and formulating a diagnosis and treatment guidelines based on the assessment findings.