#115: CMS's NEW Pediatric G Code Explained: What Every SLP Needs to Know

CMS surprised speech-language pathologists with a proposed pediatric G code, creating new questions about reimbursement, billing, and the future of pediatric speech therapy.

In this episode, Jeanette Benigas, PhD/SLP, is joined by billing expert Rick Gawenda and pediatric private practice owner Emily Watkins, MCD/SLP, to break down what the proposed G code actually means, who it applies to, and why it matters far beyond Medicare.

Topics include:
• Who the proposed pediatric G code applies to
• Why commercial insurance and Medicaid may choose different billing paths
• Timed CPT codes vs. the proposed G code
• How reimbursement could change for pediatric practices
• Operational challenges for clinics and business owners
• Why giving payers multiple billing options may create inconsistencies
• The risks surrounding untimed codes and future payer audits
• Why understanding RVUs and practice expense matters
• What clinicians and practice owners should consider before submitting comments to CMS

Whether you're an employee, private practice owner, school-based SLP, or administrator, these proposed coding changes have the potential to affect your reimbursement, documentation, scheduling, and future practice.

This episode is designed to help you understand the proposal, not tell you what position to take, so you can make informed decisions on how to comment before the CMS comment period closes.