Article Rating

  • 0 Rating(s)
  • 0
  • 0
  • 0
  • 0
  • 0

Core Evaluations and Bilingual Evaluations

This notice provides recommended guidance on billing for translation as part of a child’s core evaluation.

Currently, EI Providers that complete a child evaluation with a translator often receive separate authorizations for the core evaluation and the bilingual evaluation. Providers sometimes interpret the two authorizations as an affirmation to bill the same evaluation code twice on the same day. When a core evaluation is billed twice with the same CPT code on the same date of service, commercial payers often opt to pay the lesser billed amount of two claims.

In an effort to increase EI payments, and to ensure that the commercial payers remit payment for the core evaluation and reduce the duplicate claim denials, PCG recommends that EI Providers add translation code T1013 to the core evaluation claim when a translator is present during a child evaluation. Included below for reference are some common core evaluation codes and the translation code.

Core Evaluation Codes:

92523 – Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language).

96112 – Developmental test administration by physician or other qualified healthcare professional, with interpretation and report; first hour) was added to replace 96111. Add CPT 96113 to indicate each additional 30 minutes spent performing the activities described in 96112. (Note: 96113 cannot be billed on a separate claim, the code must be billed on the same claim which contains 96112)

Translation Code:

T1013 – Sign language or oral interpretive services, per 15 minutes.

If you have any questions, please contact the PCG Customer Service Center at (866) 315-3747.

Article ID: 442, Created On: 6/29/2020, Modified: 6/29/2020

Feedback (0)