American Speech-Language-Hearing Association

Medicare CPT Coding Rules for Speech-Language Pathology Services

This page contains important Medicare policies related to CPT coding for services rendered by speech-language pathologists, including a complete list of CPT codes and any relevant special coding rules. While these rules are set by the Centers for Medicare & Medicaid Services (CMS), they are often adopted by other third party payers. SLPs should also verify payment rules with their local Medicare Administrative Contractor.

On this page:

See also: Medicare Coding Rules for Audiology Services

Designation of Time

Most CPT/HCPCS codes reported by speech-language pathologists are "untimed" (i.e., they do not include time designations). An untimed code is billed as a session without regard to time. Exceptions for Medicare-covered codes are

  • evaluation for speech-generating device (92607, first hour; 92608, each additional 30 minutes)
  • evaluation of auditory rehabilitation status (92626, first hour; 92627, each additional 30 minutes).
  • assessment of aphasia (96105, per hour)
  • standardized cognitive performance testing (96125, per hour)
  • cognitive skills development (97532, each 15 minutes)
  • sensory integration (97533, each 15 minutes)
Note: A timed code is billed only if face-to-face time spent in an evaluation 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.

15 Minute Codes

15-Minute Codes

For CPT codes designated as 15 minutes, multiple coding represents minimum face-to-face treatment, as follows

  • 1 unit: 8 minutes to < 23 minutes
  • 2 units: 23 minutes to < 38 minutes
  • 3 units: 38 minutes to < 53 minutes
  • 4 units: 53 minutes to < 68 minutes
  • 5 units: 68 minutes to < 83 minutes
  • 6 units: 83 minutes to < 98 minutes

Code Modifiers

Untimed CPT codes represent "typical" visit lengths or times to conduct a typical test unless the time is specified in the CPT descriptor. 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. For claims with the "-22" modifier a description of the need for extended services should accompany the claim. Modifier "-59" is used to establish one procedure as distinct from another procedure billed on the same day.

Part B services provided under plans of care for speech-language pathology or dysphagia services require a GN modifier as a suffix to the CPT code. 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 annual therapy cap, a -KX modifier is required, indicating services are medically necessary and the documentation is available for review.

Same-Day Billing Restrictions

For restrictions on certain CPT code pairs billed on the same day, see Medicare's National Correct Coding Initiative (CCI) edits.

Use of Physical Medicine Codes (97000 Series)

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. Please note that cognitive therapy (97532) and sensory integration (97533) by speech-language pathologists are covered in all Medicare Local Coverage Determinations (LCDs). Some Medicare contractors may allow exceptions in Local Coverage Determinations.

CPT Codes & Special Medicare Rules for SLPs

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]

CPT Code Descriptor Special Medicare Rules
31579 Diagnostic laryngoscopy with stroboscopy Effective Oct. 1, 2011, this code can be billed by independent SLPs without supervision, unless supervision is determined by state law or regional Medicare Administrative Contractors. For more information, see ASHA's FAQs on this matter.

92506

Evaluation of speech, language, voice, communication, and/or auditory processing

Deleted, effective January 1, 2014. See new codes 92521-92524.

92507

Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual

Includes training & modification of voice prosthetics. [1] Medicare directs SLPs to use 92507 for auditory rehabilitation.

92508

Group, two or more individuals

Generally limited to 4 individuals. Limit of 25% of total SLP tx sessions is applicable to Part B patients in some intermediary Local Coverage Determinations. (For SNF Part A residents, up to 25% of each discipline's rehabilitation tx minutes per week.) [2]

See also: Medicare Guidelines for Group Therapy Treatment

92511 Nasopharyngoscopy with endoscope (separate procedure) Effective Oct. 1, 2011, this code can be billed by independent SLPs without supervision, unless supervision is determined by state law or regional Medicare Administrative Contractors. For more information, see ASHA's FAQs on this matter.
92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing) Use modifier -52 if only one test is performed (i.e., aerodynamic testing only, acoustic testing only.
92521 Evaluation of speech fluency (eg, stuttering, cluttering) New code, replaces 92506 effective January 1, 2014. See New and Revised Codes in 2014
92522 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); New code, replaces 92506 effective January 1, 2014. See New and Revised Codes in 2014
92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language)

New code, replaces 92506 effective January 1, 2014. See New and Revised Codes in 2014

For evaluation of language only, apply a modifier -52.

92524 Behavioral and qualitative analysis of voice and resonance  New code, replaces 92506 effective January 1, 2014. See New and Revised Codes in 2014

92526

Treatment of swallowing dysfunction and/or oral function for feeding

There is no dysphagia group tx code. Medicare payers may accept 97150based on section 15/230.A of the Medicare Benefit Policy Manual) or 92508 for dysphagia group tx. Please contact your local intermediary or carrier for further guidance. [3]

See also: Medicare Guidelines for Group Treatment Therapy

92597

Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech

Under Medicare, 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. [4]

92605

Evaluation for prescription for non-speech generating AAC device, face-to-face with the patient; first hour

CMS previously instructed SLPs to use 92506 for this service. [5] Because 92506 has been deleted, CMS officials state that non-SGD services (evaluation and treatment) are considered "bundled" (i.e., not separately billable) and are captured under any other service the SLP provided that day (e.g, 92523 or 92507). ASHA and CMS are investigating alternatives for those times an SLP would provide a non-SGD service alone. Currently, this would not be billable under CMS' interpretation.

92618 Evaluation [92605], each additional 30 minutes This is an add-on code for 92605.

92606

Therapeutic services for use of non-speech generating devices, including programming and modification

 

CMS previously instructed providers to use 92507 for non-SGD therapy [6], CMS has since provided different instruction. See 92605.

92607

Evaluation for prescription of speech-generating AAC device, first hour

SGDs generate synthesized or digital speech. Include -52 modifier if less than one hour. [7]

92608

Evaluation [92607], each additional 30 minutes

May be reported for evaluation spanning multiple days[8]. 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.

92609

Therapeutic services for use of speech-generating device, including programming and modification

 

92610

Evaluation of oral and pharyngeal swallowing function

 

92611

Motion fluoroscopic evaluation of swallowing function by cine or video recording

Should be billed with radiology procedure 74230. 92610 is usually reported prior to this procedure.

92612

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 if performed without cine or video recording.

92613

 interpretation and report

May be appropriate if SLP does not pass the scope but provides interpretation and report. Do not bill in addition to 92612.

92614

Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording

This is not a swallow evaluation; sensory testing only.

92615

 interpretation and report

May be appropriate if SLP does not pass the scope but provides interpretation and report. Do not bill in addition to 92614.

92616

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.

92617

interpretation and report

May be appropriate if SLP does not pass the scope but provides interpretation and report. Do not bill in addition to 92616.
92626 Evaluation of auditory rehabilitation status, first hour  
92627 Evaluation of auditory rehabilitation status, each additional 15 minutes

See Medically Unlikely Edits for restrictions on multiple billings.

92630 Auditory rehabilitation; pre-lingual hearing loss For Medicare, SLPs must use 92507 in lieu of this code [9]
92633 Auditory rehabilitation; post-lingual hearing loss For Medicare, SLPs must use 92507 in lieu of this code [10]

96105

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

There is no published rule regarding time necessary to qualify for subsequent one-hour codes. Recommend use of -52 modifier if less than 31 minute segment.

See Medically Unlikely Edits for restrictions on multiple billings.

96110

Developmental screening, with interpretation and report, per standardized instrument form

Not covered by Medicare. See G0451 at the end of this table.

96111

Developmental testing, (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments) with interpretation and report

96125 Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report.

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 note regarding time at 96105, above.

See Medically Unlikely Edits for restrictions on multiple billings.

97532

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

See 15 minute rule.

See Medically Unlikely Edits for restrictions on multiple billings.

SLPs cannot report 97532 if reporting 92507 on same day. [11]

97533

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 [12]

Verify if this code is included in the Local Coverage Determination (if a speech-language or dysphagia LCD exists).

See Medically Unlikely Edits for restrictions on multiple billings.

G0451 Developmental testing, with interpretation and report, per standardized instrument form Medicare-specific code to be used instead of 96110.

Other CPT Codes of Interest to Speech-Language Pathologists

These procedures are generally not considered to be SLP codes although some may be performed by speech-language pathologists or in collaboration with physicians. Some Medicare payers may allow payment of the listed 97000 series codes performed solely by the speech-language pathologist.

CPT Code Descriptor Special Medicare Rules
70371 Pharyngeal and speech evaluation, by cine or video

Radiologic procedure included here for information purposes and not for billing by SLPs.

74230 Swallowing function, with cineradiography/videoradiography

Radiologic procedure included here for information purposes and not for billing by SLPs; is reported with 92611. 92610 is usually reported prior to this procedure.

90901 Biofeedback training

Covered for muscle re-education of specific muscle groups [13]

97032 Electrical stimulation, manual, each 15 minutes

92526 should be billed instead of 97032

See Dysphagia Treatment with Electrical Stimulation.

97110 Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility

See Physical Medicine Codes.

97112 Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities, each 15 minutes

See Physical Medicine Codes.

97530 Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes

See Physical Medicine Codes.

97535 Self-care/home management training (eg, activities of daily living and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact by provider, each 15 minutes

See Physical Medicine Codes.

May be appropriate when necessary to observe the patient in home environment.

97537 Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology devices/adaptive equipment) direct one-on-one contact by provider, each 15 minutes

See Physical Medicine Codes

May be appropriate when necessary to observe the patient in work environment.

[1] Prosthetics: Federal Register , December 31, 2002, p. 80016.

[2] SNFs: Federal Register , July 30, 1999, p. 41662.

[3] Sec. 15/230.A of the Medicare Benefit Policy Manual: Group Therapy Services. Contractors pay for outpatient physical therapy services (which includes outpatient speech-language pathology services) and outpatient occupational therapy services provided simultaneously to two or more individuals by a practitioner as group therapy services (97150). The individuals can be, but need not be performing the same activity. The physician or therapist involved in group therapy services must be in constant attendance, but one-on-one patient contact is not required.

[4] Voice amplifiers classified as prosthetic devices: DMERC Region B Bulletin, September 2001, p. 5; DMERC Region C Advisory, Autumn 2001, p. 14.

[5] Federal Register , December 31, 2002, p. 80010

[6] Federal Register , December 31, 2002, p. 80010

[7] Federal Register, December 31, 2002, p. 80016

[8] CPT Assistant , March 2003, p. 5

[9] Federal Register, November 21, 2005, p. 70281

[10] Federal Register, November 21, 2005, p. 70281

[11] Regarding 92507: CMS Program Memorandum AB-00-14 (March 2000)

[12] Included in many intermediary SLP Local Coverage Determinations.

[13] National Coverage Determinations Manual, Chapter 1, section 30.1

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