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
Code Modifiers
Same-Day Billing Restrictions
Use of Physical Medicine Codes (97000 Series)
Additional Resources
CPT Codes & Special Medicare Rules for SLPs

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 Coding and Payment for Aural Rehabilitation Services 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 Coding and Payment of Cognitive Evaluation and Treatment Services 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.
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 in 2021. See Speech-Language Pathology CPT and HCPCS Code Changes for 2021 and Use of 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
98975	Remote therapeutic monitoring (eg, therapy adherence, therapy response); initial set-up and patient education on use of equipment	New in 2022. See Speech-Language Pathology CPT and HCPCS Code Changes for 2022 and Use of CTBS Codes During COVID-19.
98976	Remote therapeutic monitoring (eg, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days
98977	Remote therapeutic monitoring (eg, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days
98978	Remote therapeutic monitoring (eg, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor cognitive behavioral therapy, each 30 days	New in 2023. See Speech-Language Pathology CPT and HCPCS Code Changes for 2023 and Use of CTBS Codes During COVID-19.
98980	Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes	New in 2022. See Speech-Language Pathology CPT and HCPCS Code Changes for 2022 and Use of CTBS Codes During COVID-19.
98981	Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes (listed separately in addition to code for primary procedure)	New in 2022. See Speech-Language Pathology CPT and HCPCS Code Changes for 2022 and Use of CTBS Codes During COVID-19. 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.
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 in 2021. See Speech-Language Pathology CPT and HCPCS Code Changes for 2021 and Use of 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. CMS won’t pay for this code when reported by an SLP.
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. CMS won’t pay for this code when reported by an SLP.
97150	Therapeutic procedure(s), group (2 or more individuals)	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
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. CMS won’t pay for this code when reported by an SLP.
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.
98966	Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure with the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion	CMS won’t pay for these codes when reported by an SLP. See Use of CTBS Codes During COVID-19
98967	Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure with the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
98968	Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure with the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion
G2252	Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can 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 an e/m service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion	CMS won’t pay for this code when reported by an SLP. See Use of CTBS Codes During COVID-19