97165 Occupational Therapy N 1 $ 67.01 Evaluation, Low complexity, 30 minutes 97166 Occupational Therapy No 1 $67.01 Evaluation, Moderate complexity, 45 minutes 97167 Occupational Therapy No 1 $67.01 Evaluation, High Complexity, 60 minutes 97168 Occupational Therapy N 1 $ 44.34 Re-Evaluation, Established plan of care 97530 Therapeutic Activities, each 15 N 4 $ 30.56 minutes EPSDT Speech Language Pathology Description Procedure Requires Maximum Maximum Code Pre-Auth Number of Payment Units 92507 Individual N 1 $ 63.99 92508 Group N 1 $ 30.47 92521 Evaluation of speech fluency N 1 $ 91.35 92522 Evaluation of speech sound N 1 $74.00 production 92523 Evaluation of speech sound production with evaluation N 1 $153.97 of language comprehension and expression 92524 N 1 $77.40 Behavioral and qualitative analysis of voice and resonance 92526 Treatment of swallowing N 1 $80.85 dysfunction and/or oral function for feeding 92610 Evaluation of oral and N 1 $81.43 pharyngeal swallowing function
97165 Occupational Therapy Evaluation, Low complexity, 30 minutes N 1 $ 67.01 97166 Occupational Therapy Evaluation, Moderate complexity, 45 minutes No 1 $67.01 97167 Occupational Therapy Evaluation, High Complexity, 60 minutes No 1 $67.01 97168 Occupational Therapy Re-Evaluation, Established plan of care N 1 $ 44.34 97530 Therapeutic Activities, each 15 minutes N 4 $ 30.56 EPSDT Speech Language Pathology Procedure Code Description Requires Pre-Auth Maximum Number of Units Maximum Payment 92507 Individual N 1 $ 63.99 92508 Group N 1 $ 30.47 92521 Evaluation of speech fluency N 1 $ 91.35 92522 Evaluation of speech sound production N 1 $74.00 92523 Evaluation of speech sound production with evaluation of language comprehension and expression N 1 $153.97 92524 Behavioral and qualitative analysis of voice and resonance N 1 $77.40 92526 Treatment of swallowing dysfunction and/or oral function for feeding N 1 $80.85 92610 Evaluation of oral and pharyngeal swallowing function N 1 $81.43