This page provides an overview of Current Procedural Terminology (CPT® American Medical Association) coding policies for Medicare Part B (outpatient) speech-language pathology services, including a complete list of CPT codes and special coding rules. Although these coding guidelines are based on Medicare policies, keep in mind that other third party payers may adopt similar policies. CPT Assistant references are American Medical Association policies for coding best practice. Speech-language pathologists (SLPs) should also verify payment rules with their local Medicare Administrative Contractor and review ASHA's annual analysis of the Medicare Physician Fee Schedule for Medicare Part B policy changes and national payment rates.
Please contact reimbursement@asha.org for questions related to speech-language pathology services.
Most CPT/HCPCS codes reported by speech-language pathologists are untimed and do not include time designations in the code descriptor. An untimed code is billed once per day, regardless of the time spent providing the service. On the other hand, timed codes include a time designation in the descriptor (for example, "per hour", "first hour", "initial 15 minutes", "each additional 30 minutes") and may be billed multiple times per day to represent the amount of time spent in direct patient care. Bill a timed only when face-to-face time spent in evaluation or treatment is at least 51% of the time designated in the code's descriptor. An exception is 96125, where allowable time includes interpretation of test results and preparation of the report.
For CPT codes designated as 15 minutes, multiple coding represents minimum face-to-face treatment, as follows
1 unit: 8 minutes to 22 minutes
2 units: 23 minutes to 37 minutes
3 units: 38 minutes to 52 minutes
4 units: 53 minutes to 67 minutes
5 units: 68 minutes to 82 minutes
6 units: 83 minutes to 97 minutes, and so on, and so forth.
Code modifiers are appended to a CPT or HCPCS code to provide additional information about the service provided. For example, untimed codes may include modifiers to represent atypical procedures. Untimed CPT codes represent the "typical" time it takes to complete a specific evaluation or treatment. For significantly atypical procedures, a -22 modifier can be used to indicate that the work is substantially greater than typically required and a -52 modifier for an abbreviated procedure. Modifier -22 should not be used frequently because the Medicare contractor could make the determination that the procedure reflects typical service delivery. Claims with the -22 modifier require an additional description of the need for extended services. Modifiers -22 and -52 may not be used in conjunction with timed codes.
Modifier -59 is used to establish one procedure as distinct from another procedure billed on the same day, but should only be used based on instruction from the payer. Medicare publishes National Correct Coding Initiative (CC) edits that may require modifier -59.
Medicare Part B services provided under plans of care for speech-language pathology or dysphagia services also require a -GN modifier. The requirement applies to physician offices as well as facilities and private practices. Occupational therapy and physical therapy modifiers are GO and GP, respectively. For therapy services that exceed the outpatient therapy payment trigger, a -KX modifier is required, indicating services are medically necessary and that documentation is available for review.
See Medicare's National Correct Coding Initiative (CCI) edits for restrictions on certain CPT code pairs billed on the same day.
CMS staff have concluded that speech-language pathologists should not report physical medicine codes 97110 (Therapeutic exercises, each 15 minutes) and 97112 (Neuromuscular reeducation, each 15 minutes). Although CMS has not issued a formal policy statement regarding this issue, agency officials have stated their position, based on the official descriptors and vignettes for the codes. Additionally, Chapter 11, Section H-2 of the National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services states
Speech language pathologists may perform services coded as CPT codes 92507, 92508, or 92526. They do not perform services coded as CPT codes 97110, 97112, 97150, or 97530, which are generally performed by physical or occupational therapists. Speech language pathologists should not report CPT codes 97110, 97112, 97150, 97530, or 97129 as unbundled services included in the services coded as 92507, 92508, or 92526.
Please note that cognitive therapy by speech-language pathologists is covered in most Medicare Part B Local Coverage Determinations (LCDs). Some Medicare contractors may allow other exceptions in LCDs, but speech-language pathologists should also take the NCCI policies into consideration.
Note: CMS requires that the "-GN" modifier be added to every code that is rendered under a speech-language pathology or dysphagia plan of treatment (-GO indicates occupational therapy; -GP indicates physical therapy).
Evaluation of speech, language, voice, communication, and/or auditory processing
Deleted in 2014. See CPT codes 92521-92524.
Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
Includes training & modification of voice prosthetics. (Reference: Federal Register, December 31, 2002, p. 80016.)
SLPs may also use 92507 to report auditory (aural) rehabilitation.
Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, two or more individuals
Replaced 92506 effective January 1, 2014. See New Evaluation Codes for SLPs
Don't bill 92522 in conjunction with 92523.
Replaced 92506 effective January 1, 2014. See New Evaluation Codes for SLPs
For evaluation of language only, apply a modifier -52. Don't bill 92523 in conjunction with 92522.
Replaced 92506 effective January 1, 2014. See New Evaluation Codes for SLPs
92524 doesn't include instrumental assessment of voice and resonance. For instrumental assessments, see 31579, 92511, and 92520.
Treatment of swallowing dysfunction and/or oral function for feeding
Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
This code applies to tracheoesophageal prostheses (e.g. Passy-Muir Valve), artificial larynges, as well as voice amplifiers. Use 92507 for training and modification of voice prostheses.
Evaluation for prescription for non-speech generating AAC device, face-to-face with the patient; first hour
Medicare won’t pay for this code because it is considered bundled with any other speech-language pathology service provided on the same day. SLPs may not separately bill for non-speech-generating device services alone.
Evaluation for prescription for non-speech generating AAC device, face-to-face with the patient; each additional 30 minutes
*Code out of numerical sequence. This is an add-on code for 92605.
See Medically Unlikely Edits for restrictions on multiple billings and The Right Time for Billing Codes for information on how to report timed codes.
Therapeutic services for use of non-speech generating devices, including programming and modification
See 92605 for additional information on billing for non-speech generating AAC device services.
Evaluation for prescription of speech-generating AAC device; first hour
Evaluation for prescription of speech-generating AAC device; each additional 30 minutes
This is an add-on code for 92607. Additional time may be reported for an evaluation spanning multiple days. Billing must occur in conjunction with 92607 on the claim form and should be submitted using the last date of service. Do not bill 92608 separately from 92607. (Reference: CPT Assistant, March 2003, p. 5)
See Medically Unlikely Edits for restrictions on multiple billings and The Right Time for Billing Codes for information on how to report timed codes.
Therapeutic services for use of speech-generating device, including programming and modification
Evaluation of oral and pharyngeal swallowing function
Motion fluoroscopic evaluation of swallowing function by cine or video recording
92611 reflects the SLP’s work during the study. Radiologists separately report 74230 to report their participation in the study.
Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording (FEES);
This is the complete endoscopic procedure. Level of physician supervision varies by state. Use 92700 (unlisted procedure) if performed without cine or video recording.
Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording (FEES); interpretation and report only
Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording;
This is not a swallow evaluation; sensory testing only.
Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording; interpretation and report only
Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording (FEESST);
This is the complete endoscopic procedure for swallowing and sensory testing combined. Level of physician supervision varies by state and/or MAC.
Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording (FEESST); interpretation and report only
Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); each additional 15 minutes (list separately in addition to code for primary procedure)
(Use 92627 in conjunction with 92626)
(When reporting 92626, 92627, use the face-to-face time with the patient or family)
(Do not report 92626, 92627 in conjunction with 92590, 92591, 92592, 92593, 92594, 92595 for hearing aid evaluation, fitting, follow-up, or selection)
This is the add-on code to report in conjunction with 92626 for each additional 15 minutes of evaluation time. Don't report 92627 separately.
See Medically Unlikely Edits for restrictions on multiple billings and The Right Time for Billing Codes for information on how to report timed codes.
Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, eg, by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour
This is a timed code for each hour of testing.
See The Right Time for Billing Codes for information on how to report timed codes and Medically Unlikely Edits for restrictions on multiple billings.
Developmental (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments) with interpretation and report
Deleted in 2019. See 96112 and 96113
See The Right Time for Billing Codes for information on how to report timed codes and Medically Unlikely Edits for restrictions on multiple billings.
This is the add-on code for 96112.
See The Right Time for Billing Codes for information on how to report timed codes and Medically Unlikely Edits for restrictions on multiple billings.
This is a timed code for each hour of standardized testing. If billed on the same day as 92521-92524, documentation should explain the need for the cognitive evaluation in addition to the speech-language evaluation.
See The Right Time for Billing Codes for information on how to report timed codes and Medically Unlikely Edits for restrictions on multiple billings.
Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact by the provider, each 15 minutes
Deleted in 2018. See new codes 97129 and 97130.
Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact
Deleted in 2020. See new codes 97129 and 97130.
Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes
(Report 97129 only once per day)
SLPs cannot report 97129 and 97130 on the same day as 92507. For more information on same-day billing, see Medicare's CCI edits. (Reference: National Correct Coding Initiative Policy Manual for Medicare Services, Chapter 11, Section H-3)
See Medically Unlikely Edits for restrictions on multiple billings and The Right Time for Billing Codes for information on how to report timed codes.
Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes (list separately in addition to code for primary procedure)
(Report 97130 in conjunction with 97129)
(Do not report 97129, 97130 in conjunction with 97153, 97155)
New in 2020.
This is the add-on code to report in conjunction with 97129. Don't bill 97130 separately.
See The Right Time for Billing Codes for information on how to report timed codes and Medically Unlikely Edits for restrictions on multiple billings.
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact by the provider, each 15 minutes
Some LCDs may include this as a billable service for SLPs. However, ASHA does not recommend billing 97000 codes in conjunction with other 92000 codes that are typically used to report cognitive, speech, language, voice, and swallowing services.
See Use of Physical Medicine Codes for more information and Medically Unlikely Edits for restrictions on multiple billings.
Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
This is an add-on code to report in conjunction with 98980 for each additional 20 minutes of RTM treatment services during the calendar month.
Unlisted otorhinolaryngological service or procedure
Report 92700 for a covered Medicare service that does not have a corresponding CPT code. See also: New Procedures. But No Code
These procedures are generally not considered to be speech-language pathology codes billable to Medicare, although some may be performed by SLPs "incident to" a physician. This means the SLP's services are billed under the physician's NPI and the physician must be on premises when services are provided. Some MACs may allow payment of the listed 97000 series codes performed solely by the SLP.
Radiologic procedure included here for information purposes and not for billing by SLPs.
Radiologic procedure included here for information purposes and not for billing by SLPs. See 92611 to report the SLP's work during a videofluoroscopic swallow study.
Used to report muscle re-education of specific muscle groups, though none are related to speech-language pathology. (Reference: National Coverage Determinations Manual, Chapter 1, section 30.1)
Not covered by Medicare. See G0451 in Table 1 for developmental testing using a single standardized form.
Report 92526 instead of 97032 when electrical stimulation is provided as part of a full swallowing treatment session. Most MACs don't allow SLPs to bill for electrical stimulation when performed as a stand alone service. Don't report 92526 if the SLP performs only electrical stimulation.
See Physical Medicine Codes. CMS won’t pay for this code when reported by an SLP.
See Physical Medicine Codes. CMS won’t pay for this code when reported by an SLP.
See Physical Medicine Codes. Generally, CMS won’t pay for this code when reported by an SLP. However, some MACs may allow SLPs to report 97150 for group therapy for conditions not covered under 92508, such as cognition or dysphagia. See also: Medicare Guidelines for Group Therapy and Modes of Service Delivery for Speech-Language Pathology
See Physical Medicine Codes. CMS won’t pay for this code when reported by an SLP.
May be appropriate when necessary to observe the patient in the home environment.
May be appropriate when necessary to observe the patient in the work environment.
CMS won’t pay for these codes when reported by an SLP. See Use of CTBS Codes During COVID-19
CMS won’t pay for this code when reported by an SLP. See Use of CTBS Codes During COVID-19