Does G0161 require prior authorization?

Yes, G0161 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for G0161?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`G0161`, Services performed by a qualified speech-language pathologist, in the home

HCPCS/CPT

Prior Authorization

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

When billing with a Z-code as the diagnosis, document the orthotic/prosthetic device name, date the patient received the device, and the date training/teaching began (if applicable).
Document actual SLP patient contact time in 15-minute increments and link units billed to the clinical notes showing time and skilled service provided.

For SGD services billed with CPT 92607 or 92609, retain documentation supporting selection/prescription, adaptation, and training provided to the patient.

If performing a re-evaluation, document clinical rationale and use the applicable evaluation CPT code with supporting clinical findings since no separate SLP re-evaluation CPT exists.

The treatment goals and subsequent documentation of treatment results should specifically demonstrate that speech therapy services are contributing to such improvement.

Speech therapy must be provided in accordance with an ongoing, written plan of care that is reviewed with and approved by the treating physician and maintained in the medical record.

Key Coverage Criteria

Home health speech-language pathology services must be billed using HCPCS G0153 (Speech-Language Pathology).
When treating memory disturbances not associated with mental disorders (e.g., post cerebrovascular accident), use ICD-10 R68.89 as the diagnosis code for the related LCD.
Use CPT 92607 for selection and prescription of speech-generating devices (SGDs) and CPT 92609 for SGD adaptation and training.
Use CPT 92507 for speech/hearing treatment services (treatment code).
For re-evaluation in speech-language pathology, use the appropriate evaluation CPT code because CPT does not define a separate SLP re-evaluation code.
Z96.21 Presence of cochlear implant status

10 Active Policies

ANTHEM-CG-REHAB-12, Rehabilitative and Habilitative Services in the Home Setting: Physical Medicine/Physical Therapy, Occupational Therapy and Speech-Language Pathology

ANTHEM-CG-MED-23, Home Health

EVICORE-HPLAN-AETNA-EEDE1D947485, Aetna Home Health Code List - Effective 01/01/2026

A53052, Billing and Coding: Home Health Speech-Language Pathology

AETNA-CPB-0243, Speech Therapy

AETNA-CPB-0646, Voice Therapy

BCBSIL-THE803.014, Speech-Language Therapy (SLT)

BCBSMT-THE803.014, Speech-Language Therapy (SLT)

BCBSNM-THE803.014, Speech-Language Therapy (SLT)

BCBSOK-THE803.014, Speech-Language Therapy (SLT)

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G0161, Services performed by a qualified speech-language pathologist, in the home