CPT Code 92507 (2023) | Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 92507 can be used to bill services when a patient receives developmental program services like sign language, speech therapies, hearing rehabilitation, or lip-reading instruction. Most patients cannot process and communicate information between the ear and brain due to auditory disorders, even though they don’t have hearing dysfunction.

92507 CPT Code | Description & Explanation

CPT 92507 can be used to treat speech, language, voice, communication, and/or auditory processing disorder of a single patient.

The official description of CPT code 92507 is: “Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual.”

Speech therapy services include the following evaluation exam: 

• Swallowing function 
• Sound producing by speech 
• Frequency of resonance, voice, and measures 
• Duration and type of stuttering.
• Patients’ oral and written abilities 
• Study of expression and thoughts  

CPT code 92507 includes intervention or treatment (compensation, restoration, prevention, amelioration) and follow-up of speech disorders, like fluency and voice, language skills, articulation, and cognitive ability to communicate:

• A physician should refer a patient for consultation if needed.
• Improving the ability of family members or caregivers to interact with the patient while speaking, voice, communication, fluency, hearing, swallowing, disabilities, and communication.

CPT code 92507 will be billed for services when treating of auditory processing disorder of an individual, which also includes:

• Voice
• Speech
• Language
• Communication

Reimbursement

A maximum x1 92507 CPT code can be billed when documentation supports this service. The place of service is outpatient departments of hospitals, CORFs, HHAs, and hospices for CPT 92507. Modifier 26 or TC are not applicable with CPT 92507.

The reimbursement rates of CPT 92507 include the following costs and RUVS:

• Facility: Cost $85.46, RUVS 2.46950
• Non-Facility: Cost $85.46, RUVS 2.46950

Modifiers

Modifier GN will be appended with CPT 92507 for SLP (Speech-language Therapy) when billed to Medicare Part-B service. 

CPT 92507 can be reported with modifier XK if the physician attests that therapy is performed longer than usual due to exceptional circumstances and medical documentation supporting this service and is medically appropriate.

Modifier 22 will be attached to the service CPT 92507 when the service is performed longer than generally required for speech therapy.

Modifier 52 will be appended with the CPT 92507 service when the service time is reduced due to patients’ current situation or other circumstances.

Evaluation and management (CPT Codes 99202-99499) can not be billed with CPT 92507. Therefore, modifier 59 is allowed with the 92507 CPT code according to NCCI.

For instance, the patient presented to the office with a Headache in the morning and returned to the office on the same day for a speech therapy (CPT 92507) session.

Modifier 59 can be appended with CPT 92507 to unbundle the service.

Billing Guidelines

The CPT 92507 service includes tuning fork testing, Anterior rhinoscopy, removal of non-impacted cerumen otoscopy, or removal of non-impacted cerumen. Generally, E/M service does not include diagnostic/treatment service.

CPT 92507 can be denied for medical reasons when documentation does not support the service. Appropriate ICD 10 codes will be required to meet the medical necessity of documentation, and service should be medically appropriate.

If a condition is related to an injury instead of any developmental issue, it will be denied by the payer or insurance. Therefore, it is necessary to meet medical necessities according to their respective LCD/NCD.

When CPT 92507 is performed with CPT 97153, and 97155 (Adaptive Behaviour treatment), only CPT 92507 is payable service according to NCCI, and the modifier is also not allowed for these services.

If the 92507 CPT code is performed in conjunction with CPT 92633 (Auditory rehabilitation; postlingual hearing loss), or CPT 92630 (Auditory rehabilitation; prelingual hearing loss), then both the services are separately payable, and no modifier will be required as per NCCI.

If CPT 92507 is done with CPT 92601-92604 (Programming cochlear implant) on the same day, both services are separately payable, and the modifier 59 will be attached to CPT 92507 according to NCCI.

The eligible providers for service CPT 92507 are physical and occupational therapists, non-physician practitioners (NPPs), and Physicians in private practice.

The provider must have append modifier GN if performing service (CPT 92507) personally for an outpatient setting.

Documentation should justify the service (CPT 92507) if patients get prolonged services than the standard time.

Goals and recovery should be clearly described in the medical report. If the patient is not recovering or shows no improvement from therapy, the physician cannot continue this service.

CPT 92507 service cannot be performed for children who cannot speak, but it would be self-correcting in the future. These types of services are non-covered.

If a physician performs multiple therapy sessions daily, it is necessary to make separate Medical reports for each session. All treatments should not be related to earlier sessions provided by the physician.

If a patient is at the point when no improvement is seen in the future, then the physician cannot continue this service for exercises, drills, and techniques.

The treatment of Chronic cough is considerable for service (92507). Also, if any patient does not require a skilled, qualified provider for the 92507 CPT code, services can be provided by a caregiver or family member. Therefore, it is inappropriate to bill CPT 92507 for this kind of service.

Billing Examples

Below are four examples of cases when CPT code 92507 is billed appropriately.

Example 1

A 13-year-old male visited the therapist for self-orientation and to decrease confusion about remembering things by using multiple strategies like newspapers, calendars, books, and clocks to increase self-orientation ability and reduce confusion.

These strategies enhance the patient orientation skills by four times and able to learn more words. The therapist instructed 15 words to the patient and recalled all those words at 15-minute intervals.

The patient could remember six out of 15 words, and after multiple attempts, he could speak 15 by 15 words. The therapist asks questions to the patient after these attempts.

The patient was able to answer 12 out of 15 answers correctly. The patient shows good recovery and progress in this session. More sessions will be required to enhance more skills.

Billing:

CPT Code:

• CPT 92507: Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual: This code can be used to document the therapy session provided by the therapist to help the patient with communication and cognitive skills, including self-orientation and memory improvement.

ICD-10 Codes:

• ICD 10 F06.1: Organic amnesic syndrome, not induced by alcohol and other psychoactive substances: This code documents the patient’s memory issues and confusion.
• ICD 10 R41.3: Other amnesia: This code can document the patient’s memory problems and the need for therapy to improve self-orientation and recall abilities.

Example 2

A 12-year-old male presents to a therapist for a hearing dysfunction. The patient could hear all the communication but could not communicate within the ear and brain or delay receiving information.

The therapist uses multiple techniques to increase the understanding abilities of the patient by watching different videos to understand the lisping or lip-reading while one was speaking. There were five videos which were comprised of 20 words.

The patient saw these videos at 15-minute time intervals. After multiple attempts, the patient understood 12 out of 20 words and 20 out of 20 words at the end of the session.

The physician challenged the patient to understand ten words by watching videos, and he could understand 7 out of 10 words correctly. The physician scheduled another three sessions this month for a speedy recovery.

Billing:

CPT Code:

• CPT 92507: Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual: This code is used to document the therapy session provided by the therapist, which included multiple techniques to improve the patient’s understanding abilities and communication skills.

ICD-10 Code:

• ICD 10 H93.25: Auditory processing disorder: This code documents the patient’s hearing dysfunction, which affects their ability to process and understand auditory information.

Example 3

A 15-year-old male patient visited the therapist for communication issues. The patient could not communicate for over 15 seconds and got agitated and confused.

The therapist uses multiple techniques to communicate with the patient by asking his family biography questions.

The patient could not communicate initially, but after numerous attempts, the patient could communicate more words. The patient provides storybooks to the patient for readings and communications between people.

After delivering multiple training attempts to the patient, patient confusion was decreased, and able to communicate for more than 20 seconds.

Sessions were provided at 10 minutes intervals. The therapist tests the patient’s ability and challenges him to communicate for over 30 seconds.

The patient was able to communicate for 25 seconds after these training sessions. The physician scheduled the session for next week.

Billing:

CPT Code:

• CPT 92507: Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual: This code is used for the therapist’s session with the 15-year-old male patient, addressing his communication issues and utilizing multiple techniques to help improve the patient’s communication skills.

ICD-10 Code:

• ICD 10 F80.9: Speech and language development disorder, unspecified: This code is used to document the patient’s communication issues, which include difficulty in communicating for more than 15 seconds and experiencing agitation and confusion.

Example 4

A 9-year-old female presents to the speech therapist for inability to speak or pronounce words correctly and for inadequate voice. The patient was provided with multiple voice recordings and short 10-second pronouncing videos.

The therapist asks the patient to practice 12 words for voice correction and provides various training sessions at 20 minutes intervals. He asked to say his father’s and mother’s names correctly. After making multiple attempts, she could speak his family members’ names.

Next, the therapist challenged the patient to pronounce ten words, and she was to pronounce six words correctly. Treatment improves the patient’s pronunciation and voice clarity and needs more sessions in the coming weeks.

Billing:

CPT Code:

• CPT 92507: Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual: This code is used for the speech therapist’s session with the 9-year-old female patient, addressing her inability to speak or pronounce words correctly and her inadequate voice. The therapist provided voice recordings, short videos, and various training sessions to improve pronunciation and clarity.

ICD-10 Codes:

• ICD 10 F80.0: Phonological disorder: This code documents the patient’s inability to speak or pronounce words correctly.
• ICD 10 F80.8: Other developmental disorders of speech and language: This code documents the patient’s inadequate voice.