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Medicare CPT Coding Rules for Speech-Language Pathology Services

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.

On this page:

Designation of Time

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.

See also: The Right Time for Billing 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 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

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.

Same-Day Billing Restrictions

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

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. 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.

Additional Resources

CPT Codes & Special Medicare Rules for SLPs

Table 1: Services and Procedures Covered Under the Therapy Benefit

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. See: Medicare Part B Supervision Requirements for Videostroboscopy and Nasopharyngoscopy Procedures

92506

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

Deleted in 2014. See CPT codes 92521-92524.

92507

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.

92508

Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, two or more individuals

See: Medicare Guidelines for Group Treatment and Modes of Service Delivery for Speech-Language Pathology

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. See: Medicare Part B Supervision Requirements for Videostroboscopy and Nasopharyngoscopy Procedures
92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing) Use modifier -52 (reduced service) if only one test is performed (i.e., aerodynamic testing only, acoustic testing only).
92521 Evaluation of speech fluency (eg, stuttering, cluttering) Replaced 92506 effective January 1, 2014. See New Evaluation Codes for SLPs
92522 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria);

Replaced 92506 effective January 1, 2014. See New Evaluation Codes for SLPs

Don't bill 92522 in conjunction with 92523.

92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language)

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.

92524 Behavioral and qualitative analysis of voice and resonance 

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.

92526

Treatment of swallowing dysfunction and/or oral function for feeding

See: Medicare Guidelines for Group Treatment and Answers to Your Feeding/Swallowing Coding Questions

92597

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.

See: Coverage of Voice Amplifiers Under Medicare

92605

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.

92618*

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.

92606

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.

92607

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

See Medicare Coverage Policy on Speech-Generating Devices, Billing for AAC Services, and Device Documentation

92608

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.

92609

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

See Medicare Coverage Policy on Speech-Generating Devices, Billing for AAC Services, and Device Documentation

92610

Evaluation of oral and pharyngeal swallowing function

See Answers to Your Feeding/Swallowing Coding Questions

92611

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.

See Answers to Your Feeding/Swallowing Coding Questions

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 (unlisted procedure) if performed without cine or video recording.

92613

Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording (FEES); interpretation and report only

May be appropriate if SLP does not pass the scope but provides interpretation and report. Don't 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

Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording; interpretation and report only

May be appropriate if SLP does not pass the scope but provides interpretation and report. Don't 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

Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording (FEESST); interpretation and report only

May be appropriate if SLP does not pass the scope but provides interpretation and report. Don't bill in addition to 92616.
92626 Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); first hour Revised in 2020. This is a timed code for the first hour of evaluation. See Speech-Language Pathology CPT and HCPCS Code Changes for 2020 and Do's and Don'ts for Revised Implant-Related Auditory Function Evaluation Codes
92627

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.

92630 Auditory rehabilitation; pre-lingual hearing loss For Medicare, SLPs must use 92507 in lieu of this code (Reference:Federal Register, November 21, 2005, p. 70281)
92633 Auditory rehabilitation; post-lingual hearing loss For Medicare, SLPs must use 92507 in lieu of this code (Reference:Federal Register, November 21, 2005, p. 70281) 

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

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.

96111

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

96112

Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour

See The Right Time for Billing Codes for information on how to report timed codes and Medically Unlikely Edits for restrictions on multiple billings.

96113                          

Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; each additional 30 minutes (List separately in addition to code for primary procedure.)

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.

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.

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.

See also: Coding and Payment of Cognitive Evaluation and Treatment Services

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

Deleted in 2018. See new codes 97129 and 97130.

97127

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.

97129

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)

New in 2020. See Speech-Language Pathology CPT and HCPCS Code Changes for 2020.

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.

See also: Coding and Reimbursement of Cognitive Evaluation and Treatment Services

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; 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.

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

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.

98970

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

Revised, effective January 1, 2021. See Speech-Language Pathology CPT and HCPCS Code Changes for 2021 and CTBS Codes During COVID-19.

98971

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 

98972

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; 21 or more minutes
G0451 Developmental testing, with interpretation and report, per standardized instrument form Medicare-specific code to be used instead of 96110.
G0515 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 2020. See new codes 97129 and 97130.
G2250 Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment

New, effective January 1, 2021. See Speech-Language Pathology CPT and HCPCS Code Changes for 2021 and CTBS Codes During COVID-19.

G2251 Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

92700

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

Table 2: Other CPT Codes of Interest to Speech-Language Pathologists

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.

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. See 92611 to report the SLP's work during a videofluoroscopic swallow study.

90901 Biofeedback training

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)

96110 Developmental screening, with interpretation and report, per standardized instrument form

Not covered by Medicare. See G0451 in Table 1 for developmental testing using a single standardized form.

97032 Electrical stimulation, manual, each 15 minutes

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 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 the 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 the work environment.

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