Understanding CPT Coding
The CPT code set maintained by the American Medical Association (AMA) provides a uniform terminology for describing medical, surgical, and diagnostic services. It comprises over 8,000 5-digit CPT codes used to bill public and private payers. Each code refers to a specific healthcare service or procedure.
For outpatient speech therapy services, CPT codes fall under three main categories:
- Evaluation and assessment procedures
- Treatment and therapeutic intervention procedures
- Tests and measurements
Selecting the proper CPT code depends on:
- The type of service rendered
- The complexity involved
- Time spent providing the service
Proper code selection helps ensures services are reimbursed appropriately. Undercoding leads to lost revenue while overcoding can constitute fraud if not supported by documentation. Familiarity with speech therapy-specific CPT codes is key for accurate billing.
Speech Therapy Evaluation Codes
Evaluation codes are used for the initial comprehensive assessment or for periodic re-evaluations during the course of treatment. Assessments determine the extent and nature of a communication or swallowing disorder to guide the treatment plan.
- 92521: Evaluation of speech fluency
- For evaluating speech fluency and stuttering behaviors. Includes evaluation of expressive and receptive language abilities.
- 92522: Evaluation of speech sound production
For evaluating speech sound production including phonological processes. Involves testing articulation and phonological processes. - 92523: Evaluation of speech sound production with evaluation of language comprehension and expression
Combines evaluation of phonological processes with receptive and expressive language abilities. - 92610: Evaluation of oral and pharyngeal swallowing function
Evaluates the anatomy, physiology and neurology involved in the swallowing mechanism. Used for swallowing disorders (dysphagia). - 97105: Assessment of aural rehabilitation for speech and language development
Evaluates speech and language development related to hearing disorders and hearing aid use. Often used for pediatric patients. - 92626: Evaluation of auditory rehabilitation status
Determines impact of hearing loss on communication abilities and effectiveness of amplification devices. Includes counseling caregivers on auditory development. - 96105: Assessment of aphasia and cognitive skills
Measures severity of aphasia including receptive and expressive language abilities, reading, and writing skills through standardized tests. Assesses cognitive-linguistic deficits.
Speech Therapy Test Codes
The CPT codes below represent common standardized tests and measurements speech-language pathologists use during evaluations.
Each code describes a separate test component:
- 92620: Auditory function evaluation
Assessment of peripheral hearing sensitivity and cochlear function through behavioral pure tone air and bone audiometry threshold testing. - 92621: Auditory function evaluation
Evaluation of middle ear functioning and acoustic immittance testing including tympanometry and acoustic reflex threshold testing. - 96110: Developmental screening
Use of developmental screening instruments to identify patients at risk for developmental, learning or behavioral disorders. Used for brief screening only. - 96112: Developmental test administration
Administration of developmental test batteries to assess cognition, language, motor, adaptive and social skills. Used for more comprehensive testing beyond screening. - 96125: Standardized cognitive assessment using standardized instruments such as the Wechsler or Stanford-Binet
- 96127: Brief standardized assessment of cognitive function using simple assessments such as the MOCA or MMSE
Speech Therapy Treatment Codes
The CPT codes below represent common therapeutic intervention services provided during active speech-language pathology treatment:
- 92507: Treatment of speech, language, and hearing disorders
Therapeutic services for speech production, fluency, language, voice, resonance, hearing, swallowing, and cognition. May include use of equipment. - 92508: Speech therapy through telehealth
Remote treatment for speech, language, voice, resonance, or hearing disorders provided via synchronous audiovisual telehealth technologies. - 92526: Treatment of swallowing and oral feeding disorders
Therapeutic interventions for dysphagia to improve eating, feeding and swallowing abilities. May include use of specialized equipment. - 92609: Therapeutic services for use of speech device
Instructs patient in proper use of speech generating device (SGD) or augmentative communication device (ACD). Includes programming device settings. - 97129: Therapeutic interventions for cognitive rehabilitation
Treatment activities to improve cognitive-linguistic deficits such as attention, memory, reasoning, executive functioning, and problem solving. - 97532: Cognitive skills development
Therapeutic activities to improve communication deficits related to specific cognitive functions including comprehension, memory, orientation, inference, abstract thinking skills. - 92597: Oral, pharyngeal swallow treatment
Therapeutic interventions for dysphagia performed by a qualified healthcare provider involving manipulation of muscles and rehabilitation techniques to improve swallowing function during meals. Does not include simple diet modifications. - 92630: Auditory rehabilitation evaluation
Assessment of hearing loss effects on communication to determine candidacy for hearing aids and other assistive devices. Includes counseling patient or caregivers. - 92633: Auditory rehabilitation treatment
Services promoting improved understanding of speech with appropriate amplification devices and training in their use. Includes hearing strategies training. - 92606: Evaluation for prescription of nonspeech device
Exam to determine appropriate type of augmentative or alternative communication (AAC) system for patient’s needs. Includes programming and modification of device settings. - 97110: Therapeutic exercises
Active and passive therapeutic exercises to improve strength, endurance, range of motion, circulation or respiratory function. Could apply to oral motor exercises for speech. May include gait training.
Therapeutic Procedures
The codes below represent therapeutic modalities that may be incorporated into speech treatment sessions:
- 97112: Neuromuscular reeducation
Use of neuromuscular facilitation techniques to improve motor control and restore normal movement patterns. Could apply to oral motor exercises. - 97116: Desensitization techniques
Systematic, graduated exposure to stressful stimuli to reduce maladaptive anxiety associated with situations. Could apply to treating situational stuttering. - 97535: Self care management training
Teaching patients how to perform activities of daily living including eating, feeding, swallowing, cooking, etc. Applies to training dysphagic patients and caregivers. - 97542: Wheelchair management training
Teaches patients how to adequately and safely use manual or powered wheelchairs, scooters or other mobility devices.
Group and Encounter Therapy Codes
The following codes represent speech therapy services provided concurrently to more than one patient:
- 97150: Therapeutic group procedures
Speech, language, hearing, or swallowing treatment provided concurrently to two or more patients. All must require essentially identical procedures. - 97545: Group therapeutic procedures
Group treatment for patients with cognitive deficits and communication impairments. 2+ patients engaged concurrently in therapeutic exercises, activities and discussions facilitated by a clinician. All patients must require essentially identical procedures. - 92567: Group speech therapy through telehealth
Synchronous telehealth speech-language treatment for 2+ patients concurrently. Services must be appropriate for group telehealth delivery and essentially identical for each patient. - 97763: Orthotic management and training
Evaluates speech generating and augmentative communication devices (SGD/ACD) provided by durable medical equipment companies for reimbursement and patient training in their use. Billed per 30 minutes. - 92609: Therapeutic services for use of speech device
Instructs patient in proper use of speech generating device (SGD) or augmentative communication device (ACD). Includes programming device settings. - 92507: Treatment of speech, language, and hearing disorders
Bill for each 15 minutes of individual outpatient active speech-language treatment beyond the first 60 minutes (with modifier –52 appended). - 92608: Evaluation for prescription of speech device
Exam to determine type of speech generating or augmentative communication device appropriate for patient’s needs and abilities. - 97161: Evaluation of physical therapy, low complexity
Used by SLPs for an encounter lasting under 15 minutes for a brief assessment . Not to be used for full initial evaluation. - 97162: Evaluation of physical therapy, moderate complexity
Encounter lasting 15-30 minutes in duration. Appropriate for re-evaluation of established patients. - 97163: Evaluation of physical therapy, high complexity
Encounter lasting over 30 minutes for a comprehensive re-evaluation of an established patient’s status.
Selecting the Right Codes
Some key considerations when selecting CPT codes for speech-language pathology services:
- Code for the complexity of the assessment, not just time spent. Performing additional elements during testing warrants a higher complexity code.
- Only use evaluation codes for the initial assessment and periodic re-evaluations, not ongoing treatment sessions.
- Select test codes based on each separate component of the assessment battery administered.
- For treatment, choose codes that closely align with the specific therapeutic interventions performed during a session.
- Use time-based add-on codes like 92507 with a –52 modifier for any treatment time beyond the first
Reporting Requirements
Proper documentation is critical when submitting CPT codes for speech therapy services.
Treatment notes should include:
- Date, length and type of each service performed
- Specific tests, assessments, exercises carried out
- Equipment used during interventions
- Patient’s response to evaluation or treatment
- Progress toward goals
All services must be medically necessary for the patient’s condition in order to qualify for reimbursement. Ongoing progress notes should demonstrate continued therapeutic benefit and functional improvement.
For evaluations, results of each test component should correlate to the appropriate CPT codes selected. The written report should summarize assessment findings, interpretation, and recommendations.
When billing group treatment, notes must show the interventions were essentially identical for each group member. Any individualized treatments or differences in service time/complexity should be coded separately.
Stay Up to Date
Speech therapy billing is complicated by frequently changing insurer policies, coding definitions, and regulations. Therapists should regularly review payer guidelines and audit their documentation to ensure compliance. Ongoing CPT code education ensures proper code selection as new codes are introduced or definitions evolve.
Partnering with experienced medical billers and coders can provide invaluable expertise navigating reimbursement requirements. Outsourced revenue cycle management services equipped to handle speech therapy billing nuances enable clinicians to focus on delivering optimal care without revenue concerns.
Speech therapy services play a critical role in restoring function for patients with communication and swallowing disorders. However, navigating the complex landscape of CPT codes, documentation requirements, and evolving payer policies presents challenges for therapist reimbursement. By staying up to date on billing best practices, partnering with experienced coders, and accurately selecting CPT codes that capture the complexity of services provided, speech-language pathologists can ensure their hard work is fairly reimbursed. Proper speech therapy billing processes allow clinicians to focus on delivering the individualized, highly skilled treatments that tangibly improve quality of life for people experiencing speech, language, and cognitive deficits.
