insurance codes

Please Read Health Insurance Reimbursement Tips on TACA’s Website. It has great information on medical codes (including codes for biomedical treatment) and on the coding process.

Please note: Insurance coding is a tricky area. Different insurance carriers may accept/require different codes. I recommend that you ask your child’s various therapists for the codes they typically use. Here are some codes that may be helpful:

Diagnostic Codes related to Occupational Therapy
279.11 DiGeorge Syndrome
299.00 Autism
299.8 Pervasive Developmental Disorder/Asperger’s Syndrome
314.0 Attention Deficit Disorder
314.01 Attention Deficit Disorder with Hyperactivity
315.4 Developmental Coordination Disorder – Dyspraxia
315.8 Delay in Development (specified)
315.9 Delay in Development (unspecified)
343.9 Cerebral Palsy
348.3 Encephalopathy
349.9 Unspecified Disorders of the Nervous System
374.44 Sensory Processing Disorder
382.9 Otitis Media
742.9 Unspecified Anomaly of the Brain, Spinal Cord and Nervous System
759.83 Fragile X Syndrome
781.3 Lack of Coordination – Dyspraxia
781.0 Tremors Nervous System
782.0 Disturbance of Skin Sensation
784.69 Motor Apraxia
Evaluation Codes related to Occupational Therapy
96110 OT Evaluation – Developmental Assessment Interpretation, Report
96111 OT Evaluation – Extended Standardized Developmental Instruments
96115 Neurobehavioral Status Exam with Interpretation Report
Treatment Codes related to Occupational Therapy
97110 Therapeutic Procedure – Develop Strength/Endurance, ROM
97112 Neuromuscular Re-Education – Balance, Coord., proprio.
97530 Therapeutic Activities – Improve Functional Performance
97533 Sensory Integration Techniques
97535 Self – Care/ADL Training

 

Diagnostic Codes related to Speech and Language Therapy
299.9 Unspecified Pervasive Developmental Disorder (PDD-NOS)
299.00 Autism
314.01 Attention Deficit, Childhood with Hyperactivity
315.31 Language Disorder, Dev. -Aphasia, Word Deafness
315.39 Articulation Disorder, Dev. -Dyslalia
388.4 Auditory Perception, Abnormal
784.4 Voice Disorder
784.69 Apraxia
787.2 Dysphagia
Evaluation and Treatment Codes related to Speech and Language Therapy
92506 Evaluation of Speech, Language, Voice, Communication, Auditory Processing and/or Aural Rehabilitation Status
92507 Treatment of Speech, Language, Voice, Communication, Auditory Processing, Individual Therapy
92508 Group, Two or More Individuals
97532 Development of Cognitive Skills to Improve Attention, Memory, Problem Solving, Direct One-on-One Patient Contact by the Provider
97533 Sensory Integrative Techniques to enhance sensory Processing and Promote Adaptive Responses to Environmental Demands
92520 Laryngeal Function Studies
96105 Assessments of Aphasia
96110 Developmental Testing, Limited, with Interpretation and Report
Swallowing Function
92526 Treatment of Swallowing Dysfunction and/or Oral Function for Feeding
92610 Evaluation of Swallowing Function

 

Diagnostic Codes related to Applied Behavioral Analysis
299.00 Autism
Treatment Codes related to Applied Behavioral Analysis
You will find that ABA providers will use different codes. Ask your provider if they already have codes that they have used successfully. If not, the following codes may help. For a full description, you can look up these codes at the AMA website.
90808 Director Level
90806 Tutor Level