Can You Bill Insurance for Interpreter Services?

Billing insurance for interpreter services can be complex, but is often achievable. The growing need for accessible language services in healthcare requires understanding insurance policies and federal guidelines. This article clarifies pathways for billing interpreter services, outlining necessary conditions and procedural steps.

Understanding Insurance Coverage for Interpreter Services

Interpreter services are recognized as a component of comprehensive healthcare for individuals with Limited English Proficiency (LEP) or communication barriers. Coverage varies across insurance types, including federal and private plans. Federal laws, such as Title VI of the Civil Rights Act of 1964 and the Americans with Disabilities Act (ADA), mandate that healthcare providers receiving federal financial assistance ensure effective communication, often requiring interpreter services.

Medicaid programs cover interpreter services for eligible beneficiaries, recognizing the importance of language access for medical and administrative purposes. While states are not federally mandated to reimburse providers directly, many state Medicaid programs offer reimbursement as a medical assistance or administrative expense. Coverage includes in-person, video remote, and telephonic interpretation, provided at no cost to the beneficiary.

Medicare does not offer a direct benefit for foreign interpreter services. However, some Medicare Advantage plans may include interpreter services for members. Healthcare providers are obligated under federal laws to provide qualified interpreter services to ensure effective communication, particularly for individuals who are deaf or hard of hearing or have limited English proficiency. Private insurance coverage for interpreter services is variable, depending on policy and state regulations; some plans may allow billing for the increased time an interpreter’s presence adds to an encounter.

A condition for insurance coverage is demonstrating “medical necessity.” Interpreter services must be integral to the patient’s medical care, ensuring accurate communication of diagnoses, treatment plans, and medical history. Services must be provided by qualified interpreters with demonstrated proficiency and adherence to ethical principles, not untrained bilingual staff or family members.

Essential Information for Billing Interpreter Services

Patient information is essential for claims, including full name, date of birth, and complete insurance policy details. This ensures the claim links correctly to the individual receiving care and their benefits.

Provider information is important for claim processing. This includes the rendering provider’s National Provider Identifier (NPI), tax identification number, and the name and address of the facility where services were provided.

Details specific to the interpreter and service provided are necessary. This includes the interpreter’s full name, qualifications (such as certification or specialized training), and agency affiliation if not directly employed by the facility. Documentation should specify:
Date of service
Exact start and end times
Specific language or type of interpretation (e.g., American Sign Language, Spanish)
Mode of delivery (e.g., in-person, video remote interpreting, telephonic)

Procedure codes describe services rendered. For interpreter services, Healthcare Common Procedure Coding System (HCPCS) Level II code T1013, “Sign language or oral interpretive services, per 15 minutes,” is used. This time-based code is billed in 15-minute increments, with rounding rules often allowing a full unit if at least eight minutes of service are provided. Modifiers may be required for additional details, such as language type (e.g., U1 for spoken language, U3 for sign language) or delivery method (e.g., GT for services via interactive audio and video telecommunication systems).

Diagnosis codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) establish the medical necessity of the encounter. An appropriate diagnosis code must be selected to support why the patient needed medical attention and an interpreter was required. Documentation in the patient’s medical record must detail the medical necessity for interpreter services, the interpreter’s name, and the precise duration. This record supports the claim.

Submitting Claims for Interpreter Services

The next step is submitting the claim to the appropriate payer. For professional services, the standard claim form is the CMS-1500, used by non-institutional providers and suppliers to bill for services.

When completing the CMS-1500 form:
Patient’s insurance details, including type, are entered in Box 1, and the insured’s ID number in Box 1a.
Patient demographic information, such as name, date of birth, and address, is placed in Boxes 2, 3, and 5.

The diagnosis code, supporting medical necessity, is entered in Box 21. In Box 24D, HCPCS code T1013, with applicable modifiers (such as U1, U3, or GT), denotes the interpreter service. Charges for the interpreter service are recorded in Box 24F, and units (15-minute increments) in Box 24G. Service facility information, including its National Provider Identifier (NPI), is entered in Box 32.

Claims can be submitted as paper forms or electronically. Paper claims involve mailing the completed CMS-1500 form to the payer. Electronic submission, often preferred for efficiency, occurs through a healthcare clearinghouse or directly via payer portals, utilizing electronic data interchange (EDI) formats like the 837P.

After submission, the claim undergoes processing by the insurance payer. The provider receives an Explanation of Benefits (EOB) or an Electronic Remittance Advice (ERA), detailing the payer’s decision, including payment or reasons for denial. Processing times vary, from a few weeks to several months, depending on the payer and claim complexity.