Does G0451 require prior authorization?

No, G0451 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for G0451?

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

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`G0451`, Development testing, with interpretation and report, per standardized

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

The patient's medical record must contain documentation that fully supports the medical necessity of the services provided.
For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

Diagnosis code(s) reported on the claim must best describe the patient's condition for which the service was performed; missing or invalid codes will result in claim return.

Because CPT does not define a re-evaluation code for speech-language pathology, use the evaluation CPT code to report re-evaluations and document minutes the same as for initial evaluations.

Modifier -GN must be used to identify services delivered personally by an SLP or provided under an outpatient speech-language pathology Plan of Care.

For pre-laryngectomy examinations report ICD-10-CM code Z01.818 on the claim.

Key Coverage Criteria

Speech-language pathology services are covered for diagnosis and treatment of speech and language disorders that result in communication disabilities.
Speech-language pathology services are covered for diagnosis and treatment of swallowing disorders (dysphagia).
Services are covered when provided by a qualified speech-language pathologist who holds a Certificate of Clinical Competence (CCC-SLP) or is in the clinical fellowship year (CFY) accumulating supervised experience required for certification.
Services are covered when they are a specific and effective treatment under accepted standards of medical practice for the patient's condition.
Services are covered when the level of complexity or the patient's condition requires that the services can be safely and effectively performed only by or under the supervision of a qualified therapist (skilled care required).
Rehabilitative therapy is covered when the patient has potential to improve or is improving, maximum improvement has not been attained, and anticipated improvement is attainable in a reasonable and generally predictable period.

12 Active Policies

A56937, Billing and Coding: Psychiatry and Psychology Services

NGS-J6-L33580, Speech-Language Pathology

NGS-J6-L33632, Psychiatry and Psychology Services

A52866, Billing and Coding: Speech-Language Pathology

FIRST_COAST-L34520, Psychological and Neuropsychological Tests

A57780, Billing and Coding: Psychological and Neuropsychological Tests

NOVITAS-JH-L35101, Psychiatric Codes

NGS-JK-L33632, Psychiatry and Psychology Services

NGS-JK-L33580, Speech-Language Pathology

A57130, Billing and Coding: Psychiatric Codes

NOVITAS-JL-L35101, Psychiatric Codes

CIGNA-A004, Preventive Care Services

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G0451, Development testing, with interpretation and report, per standardized