Speech Therapy Billing Codes And Reimbursement Rates

To keep a healthy revenue cycle, it's important to understand speech therapy billing codes and reimbursement rates. Correct CPT and ICD-10 coding is essential for speech-language pathologists (SLPs) and healthcare practices to receive the timely reimbursements they deserve from Medicare, Medicaid, and private insurance companies. However, evolving payer guidelines, documentation requirements, and coding updates can make the billing process challenging. 

A few coding mistakes can result in claim denials, delayed payments, or lost revenue. The purpose of this guide is to provide you with a list of the most frequently used speech therapy billing codes, how they are determined, some common speech therapy billing issues, and strategies for achieving accurate billing and maximizing the productivity of your practice. 

Speech Therapy Treatment Codes and Reimbursement Rates

The codes are the basic building blocks of speech therapy billing since they are utilized every time the patient gets therapy services. Most speech-language pathology (SLP) treatment codes are untimed which means they are charged for each treatment session, without regard to the duration of the session. 

But, cognitive-communication therapy codes are time-based and have to comply with Medicare's 8-minute rule.  Selecting the right treatment code, along with knowing the treatment code reimbursement rate, can help providers minimize claim denials and maximize revenue. 

CPT Code 92507 – Individual Speech-Language Treatment

Service: Treatment for speech, language, voice, communication, and/or auditory processing disorder (one-on-one).

• Code Type: Untimed
• Estimated Medicare Reimbursement: ~$85.53
• Estimated Commercial Insurance Reimbursement: $85–$110

Billing Tips:

• One of the most frequently billed speech therapy codes.
• Bill once per therapy session.
• Do not bill on the same day as speech-language evaluation codes unless payer guidelines allow.
• A GN modifier is required for Medicare claims.

CPT Code 92508 – Group Speech-Language Treatment

Service: Group treatment for speech, language, voice, communication, and/or auditory processing disorders.

• Code Type: Untimed
• Estimated Medicare Reimbursement: ~$24.05
• Estimated Commercial Insurance Reimbursement: $20–$38

Billing Tips:

• Bill once for each group therapy session involving two or more patients.
• Most insurance payers do not allow billing 92508 and 92507 for the same patient on the same day.

CPT Code 92526 – Swallowing and Feeding Therapy

Service: Treatment of swallowing dysfunction and oral function for feeding (dysphagia therapy).

• Code Type: Untimed
• Estimated Medicare Reimbursement: ~$84.11
• Estimated Commercial Insurance Reimbursement: $80–$105

Billing Tips:

• Bill once per treatment day.
• May be billed on the same day as swallowing evaluation codes 92610 or 92611, depending on payer policies.
• Documentation should clearly support treatment goals outlined in the patient's Plan of Care.

CPT Code 97129 – Cognitive-Communication Therapy (First 15 Minutes)

Service: Therapeutic interventions for cognitive function deficits (first 15 minutes).

• Code Type: Timed
• Estimated Medicare Reimbursement: ~$44.52
• Estimated Commercial Insurance Reimbursement: $42–$65

Billing Tips:

• Time-based code that follows the Medicare 8-minute rule.
• If billed with 92507, Modifier 59 may be required when services are separate and medically necessary.
• Documentation must distinguish cognitive treatment from speech-language therapy.

CPT Code 97130 – Cognitive-Communication Therapy (Each Additional 15 Minutes)

Service: Additional 15-minute cognitive therapy session following CPT 97129.

• Code Type: Timed Add-on
• Estimated Medicare Reimbursement   : ~$33.22
• Estimated Commercial Insurance Reimbursement: $30–$50

Billing Tips:

• Can only be billed with 97129.
• Cannot be reported as a standalone code.
• Record total treatment minutes to support every additional unit billed.

Speech Therapy Evaluation Codes and Reimbursement Rates

Evaluation codes are used to consider the speech, language, voice, cognitive or swallowing function of the patient prior to treatment. The correct CPT code is dependent upon what was evaluated, rather than the diagnosis of the patient. It is important to identify the appropriate evaluation code for proper reimbursement and compliance. An audit concern stems from the over-billing of comprehensive evaluation codes, specifically CPT 92523, when only a limited evaluation was performed. 

A note on billing rules, Medicare usually does not allow billing an evaluation code and CPT 92507 (treatment) on the same day. Providers should always check with payers regarding any same-day billing policies but some commercial insurers may allow this to occur with proper documentation and Modifier 25. 

CPT Code 92521 – Speech Fluency Evaluation

Service: Evaluation of speech fluency disorders, including stuttering and cluttering.

• Code Type: Untimed
• Estimated Medicare Reimbursement   : ~$133.09
• Estimated Commercial Insurance Reimbursement: $125–$165

Billing Tips:

• Use only when the assessment focuses specifically on fluency disorders.
• Do not report 92523 unless language abilities were also formally evaluated.

CPT Code 92522 – Speech Sound Production Evaluation

Service: Evaluation of articulation, phonological disorders, apraxia of speech, and dysarthria.

• Code Type: Untimed
• Estimated Medicare Reimbursement   : ~$111.78
• Estimated Commercial Insurance Reimbursement: $105–$145

Billing Tips:

• Appropriate when evaluating speech sound production only.
• Does not include a language assessment.
• Should not be billed on the same day as 92523.

CPT Code 92523 – Speech and Language Evaluation

Service: Evaluation of speech sound production along with language comprehension and expressive language.

• Code Type: Untimed
• Estimated Medicare Reimbursement: ~$226.12
• Estimated Commercial Insurance Reimbursement: $145–$185

Billing Tips:

• Both speech and language components must be formally assessed.
• One of the highest reimbursed speech therapy evaluation codes.
• Frequently audited, so complete documentation is essential.

CPT Code 92524 – Voice and Resonance Evaluation

Service: Behavioral and qualitative assessment of voice quality, pitch, resonance, and vocal function.

• Code Type: Untimed
• Estimated Medicare Reimbursement: ~$109.05
• Estimated Commercial Insurance Reimbursement: $100–$140

Billing Tips:

• It’s designed specifically for voice disorder evaluations.
• Should not replace articulation or language evaluation codes.

CPT Code 92610 – Clinical Swallowing Evaluation

Service: Clinical evaluation of oral and pharyngeal swallowing function without instrumental testing.

• Code Type: Untimed
• Estimated Medicare Reimbursement: ~$84.77
• Estimated Commercial Insurance Reimbursement: $80–$110

Billing Tips:

• Commonly performed as a bedside swallowing assessment.
• May be billed on the same day as CPT 92526 when medically appropriate.

CPT Code 92611 – Modified Barium Swallow Study (MBS)

Service: The goal of the service is to obtain a motion fluoroscopic evaluation of swallowing function. 

• Code Type: Untimed
• Estimated Medicare Reimbursement: ~$91.46
• Commercial Reimbursement: Typically physician-billed

Billing Tips:

• It is used for Modified Barium Swallow (MBS) studies.
• Speech-language pathologists should verify payer credentialing requirements prior to billing. 

CPT Code 92612 – Flexible Endoscopic Evaluation of Swallowing (FEES)

Service: Endoscopic evaluation of swallowing (no sensory testing). 

• Code Type: Untimed
• Estimated Medicare Reimbursement: ~$199.33
• Estimated Commercial Insurance Reimbursement: $180–$250

Billing Tips:

• Must have documented medical necessity.
• Depending on the level of care, charges may be separately billed for the facility.

CPT Code 92613 – FEES Interpretation

Service: Physician interpretation of a Flexible Endoscopic Evaluation of Swallowing.

• Code Type: Untimed
• Estimated Medicare Reimbursement: ~$35.67
• Commercial Reimbursement: It is mostly billed by a physician

Billing Tips:

• Covers interpretation only.
• Must be recorded as a separate document from the procedure.

CPT Code 92614 – FEES with Laryngeal Sensory Testing

Service: Flexible Endoscopic Evaluation of Swallowing combined with sensory testing.

• Code Type: Untimed
• Estimated Medicare Reimbursement: ~$151.38
• Estimated Commercial Insurance Reimbursement: $140–$190

Billing Tips:

• The higher reimbursement is due to the added sensory assessment.
• The medical indication for sensory testing should be thoroughly explained in documentation. 

CPT Code 92615 – Laryngeal Sensory Interpretation

Service: Aims to interpret laryngeal sensory testing conducted during FEES. 

• Code Type: Untimed
• Estimated Medicare Reimbursement: ~$32.01
• Commercial Reimbursement: It is typically physician-billed

Billing Tips:

• It covers interpretation only.
• By following the payer guidelines, report separately when applicable.

CPT Code 92616 – FEES with Sensory Testing

Service: Comprehensive Flexible Endoscopic Evaluation of Swallowing, including sensory testing.

• Code Type: Untimed
• Estimated Medicare Reimbursement: ~$228.49
• Estimated Commercial Insurance Reimbursement: $210–$280

Billing Tips:

• One of the highest reimbursed dysphagia evaluation procedures.
• Requires complete clinical documentation supporting the procedure and findings.

CPT Code 92617 – Laryngeal Sensory Test Interpretation

The background information regarding the laryngeal sensory testing conducted during FEES. 

• Code Type: Untimed
• Estimated Medicare Reimbursement: ~$35.67
• Commercial Reimbursement: Typically physician-billed

Billing Tips:

• Physician interpretation code.
• Documentation should be maintained separately from the procedural report.

CPT Code 92520 – Laryngeal Function Studies

Service: Acoustic and aerodynamic evaluation of laryngeal function and voice performance.

• Code Type: Untimed
• Estimated Medicare Reimbursement: ~$90.74
• Estimated Commercial Insurance Reimbursement: $85–$120

Billing Tips:

• Used for specialized voice assessments.
• Some payers may bundle this service with other evaluation codes, so verify coverage before billing.

AAC Device and Specialty Speech Therapy Billing Codes and Reimbursement Rates

Patients who need communication devices or special voice rehabilitation services are provided with augmentative and alternative communication (AAC) and specialty billing codes. These codes include evaluations, device selection, programming, therapeutic training, and voice prosthesis evaluations. Documentation is critical because many insurance companies have medical necessity, device trials, and measurable functional outcomes criteria for reimbursement. 

CPT Code 92605 – Evaluation for Non-Speech-Generating AAC Device

Service: Evaluation for prescribing a non-speech-generating Augmentative and Alternative Communication (AAC) device during the first hour.

• Code Type: Untimed
• Estimated Medicare Reimbursement: ~$122.49
• Estimated Commercial Insurance Reimbursement: $115–$160

Billing Tips:

• Commonly used for pediatric patients under age seven or when payer-specific criteria apply.
• Always verify age restrictions and coverage policies with the insurance provider.
• Documentation should clearly justify the need for a non-speech-generating communication device.

CPT Code 92606 – Therapeutic Service for Non-Speech-Generating AAC Device

Service: Therapy focused on training patients to use a non-speech-generating AAC device effectively.

• Code Type: Untimed
• Estimated Medicare Reimbursement: ~$102.37
• Estimated Commercial Insurance Reimbursement: $95–$135

Billing Tips:

• Used for ongoing therapy rather than the initial evaluation.
• Document patient progress, functional improvements, and communication goals during each session.

CPT Code 92607 – Evaluation for Speech-Generating AAC Device

Service: Initial evaluation for prescribing a speech-generating communication device (SGD).

• Code Type: Untimed
• Estimated Medicare Reimbursement: ~$122.49
• Estimated Commercial Insurance Reimbursement: $115–$160

Billing Tips:

• Covers comprehensive assessment and device trials.
• Documentation should include comparisons of several different speech-generating devices and describe why the device is chosen to best meet the patient's communication needs. 

CPT Code 92608 – Additional AAC Evaluation Time

Service: Each additional 30 minutes spent evaluating a speech-generating AAC device.

• Code Type: Untimed Add-on
• Estimated Medicare Reimbursement   : ~$47.69
• Estimated Commercial Insurance Reimbursement: $44–$65

Billing Tips:

• This is an add-on code that must be billed with CPT 92607.
• Record the total additional evaluation time and clinical activities performed during the extended assessment.

CPT Code 92609 – Therapeutic Service for Speech-Generating AAC Device

Service: Therapy for programming, training, and optimizing the use of a speech-generating communication device.

• Code Type: Untimed
• Estimated Medicare Reimbursement   : ~$102.37
• Estimated Commercial Insurance Reimbursement: $95–$135

Billing Tips:

• Covers device programming, customization, and patient education.
• Documentation should include device settings, communication performance, and progress toward functional communication goals.

CPT Code 92597 – Voice Prosthesis Evaluation

Service: Evaluation for the use of a voice prosthesis to supplement or restore oral speech after laryngectomy.

• Code Type: Untimed
• Estimated Medicare Reimbursement: ~$71.04
• Estimated Commercial Insurance Reimbursement: $65–$95

Billing Tips:

• Usually used in patients after Total Laryngectomy. 
• Medical records should include surgical history, clinical findings, and documentation supporting the medical necessity for the voice prosthesis evaluation.

Speech Therapy Billing Modifiers: When to Use Them

Modifiers are two-character codes appended to CPT or HCPCS codes to provide additional information about the service rendered. In speech-language pathology (SLP) billing, modifiers play a critical role in ensuring claims are processed correctly by Medicare, Medicaid, and commercial insurance providers. Missing or incorrectly applying a required modifier can result in automatic claim denials, delayed reimbursements, or payer audits.

Below are the most commonly used modifiers in speech therapy billing and when they should be applied.

Modifier GN – Speech-Language Pathology Plan of Care

Purpose: Indicates that speech-language pathology services were provided under an outpatient SLP plan of care.

When to Use:

• Required on every Medicare Part B speech therapy claim.
• Confirms that services were performed by or under the supervision of a qualified speech-language pathologist.

If Omitted:

• Medicare will automatically deny the claim.

Modifier KX – Medical Necessity Above the Therapy Threshold

Purpose: This modifier is used to certify that therapy services remain medically necessary. But the condition is that it must be used after the annual therapy spending threshold has been exceeded.

When to Use:

• When the combined cost of physical therapy (PT) and speech therapy (SLP) are not covered under the Medicare yearly limit for the amount of money that can be spent on those therapies ($2,480 in 2026). 
• Documentation needs to continue to support medical necessity. 

If Omitted:

• Payments for claims above the therapy limit are likely to be refused. 

Modifier 95 – Synchronous Telehealth Services

Purpose: Identifies services delivered through real-time audio and video telecommunication.

When to Use:

• Required for eligible telehealth speech therapy services, including codes such as 92507, 92508, 92521–92524, and 92526.
• Medicare currently allows eligible SLP telehealth services through December 31, 2027.

If Omitted:

• Claims may be processed incorrectly as in-person services or denied.

Modifier GT – Legacy Telehealth Modifier

Purpose: Identifies interactive telehealth services for payers that still require the GT modifier.

When to Use:

• Some state Medicaid programs require GT instead of Modifier 95.
• Always verify individual payer guidelines before billing.

If Omitted:

• Medicaid claims may be denied if the incorrect telehealth modifier is used.

Modifier 93 – Audio-Only Telehealth

Purpose: Audio-only communication services without video. 

When to Use:

• Only use when the audio-only speech therapy service is covered by the payer. 
• Coverage varies among commercial insurers and Medicaid programs.

If Omitted:

• Audio-only telehealth claims may be rejected or denied.

Modifier 52 – Reduced Services

Purpose: Indicates that a service was partially completed or reduced.

When to Use:

• Appropriate when an evaluation begins but cannot be completed, such as an incomplete CPT 92523 assessment.

If Omitted:

• There may be documentation issues that can result in not reimbursing all for an audit risk. 

Modifier 59 – Distinct Procedural Service

Purpose: Shows that two procedures performed on the same day were separate and medically necessary.

When to Use:

• Used often in conjunction with CPT 92507 and 97129 on the same date.
• Documentation must clearly demonstrate different treatment objectives.

If Omitted:

• The secondary procedure may be automatically denied due to National Correct Coding Initiative (NCCI) edits.

Modifier GP – Physical Therapy Plan of Care

Purpose: Identifies services delivered under a physical therapy plan of care.

When to Use:

• Rarely used in speech therapy.
• Apply only when speech-language pathology services are officially billed under a PT plan of care.

If Omitted or Used Incorrectly:

• May result in plan-of-care errors, claim denials, or payer audits.

Modifier 22 – Increased Procedural Services

Purpose: Indicates that the procedure required substantially greater effort than usual.

When to Use:

• Use only in response to clear documentation of additional complexity or work. 

If Omitted:

• Providers may miss the opportunity for additional reimbursement when justified.

Modifier 25 – Significant, Separately Identifiable Evaluation and Management (E/M) Service

Purpose: Indicates that a separate Evaluation and Management (E/M) service was performed on the same day as another procedure.

When to Use:

• Primarily applicable in multidisciplinary or integrated healthcare practices where SLPs also report E/M services.
• Depending on the policy, some commercial carriers may bill for the same day evaluation and treatment with Modifier 25. 

If Omitted:

• The Evaluation and Management service may be denied or bundled into the procedural claim.

2026 Updates to Speech Therapy Billing Codes and Reimbursement Rates

Knowing about the annual coding and reimbursement changes is critical for ensuring accurate billing and maximizing revenue. In 2026, there were several key changes that came into effect for Medicare reimbursements, Remote Therapeutic Monitoring (RTM), therapy thresholds, and specialty coding. Meanwhile, numerous key rate adjustments of 2025 continue to apply. 

Key Changes Effective January 1, 2026

• Higher reimbursement for CPT 92507: Medicare increased the national non-facility reimbursement rate for CPT 92507 by approximately 2%, bringing the average payment to around $85.53. This code is also exempt from the 2.5% outpatient efficiency adjustment.
• Expanded Remote Therapeutic Monitoring (RTM): New RTM codes 98984, 98985, and 98979 now allow providers to bill for 2–15 days of monitoring and 10–19 minutes of clinician interaction, making short-term remote therapy monitoring reimbursable.
• Updated RTM billing requirements: Existing RTM device supply codes 98976, 98977, and 98978 now clearly require 16–30 days of transmitted monitoring data to qualify for reimbursement.
• Audiology code revisions: Previous hearing device codes 92590–92595 have been replaced by CPT 92628–92642. Practices offering audiology-related services should update their coding and billing processes accordingly.
• New ICD-10 diagnosis codes: There are now new code options for some genetic communication disorders and Primary Progressive Apraxia of Speech (PPAOS) to provide a more accurate clinical picture. 
• Higher Medicare therapy threshold: The combined Physical Therapy (PT) and Speech-Language Pathology (SLP) therapy threshold increased to $2,480 in 2026. Once this limit is exceeded, providers must append the KX modifier to certify continued medical necessity.
• Extended telehealth coverage: Medicare has extended telehealth eligibility for speech-language pathology services through December 31, 2027, providing greater billing stability for virtual care.

Achieve a 98.99% Clean Claim Rate with BillingFreedom's Speech Therapy Billing Services

Managing rehabilitation therapy billing requires more than submitting claims. It demands coding accuracy, payer compliance, and efficient revenue cycle management. BillingFreedom helps speech-language pathology (SLP) practices streamline their billing operations with a team of certified medical billing specialists who understand the complexities of speech therapy coding and reimbursement.

Our experts will ensure accurate CPT coding, ICD-10 coding, insurance verification, timely claims submission, payment posting, denial management, and end-to-end Revenue Cycle Management (RCM). All claims are handled with HIPAA-compliant processes, and you will be supported by a dedicated account manager who will share performance updates and offer customized support. 

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As an independent SLP or expanding therapy practice, BillingFreedom can help maximize reimbursements, minimize administrative burden, and maintain an efficient revenue cycle, allowing you to focus on providing high-quality patient care. 

To learn more about our Mental Health billing services, you may not hesitate to get in touch with us through email at info@billingfreedom.com or call us at +1 (855) 415-3472. 

Our priority is your financial peace of mind!