Speech Therapy CPT Codes (2022) Description, Guidelines, Reimbursement, Modifiers & Examples

Speech therapy CPT codes 92607 may choose and prescribe speech-generating equipment, whereas CPT 92609 adapts and teach users.

Speech Therapy CPT Codes Summary

Treatment is under the Speech therapy CPT codes 92507 code for speech, language, voice, communication, and auditory processing issues. Each patient goes through a variety of developmental programs under the supervision of a doctor. Here are a couple of such examples:

• Sign language is a communication strategy used in speech treatment.
• Lip-reading training
• Auditory system rehabilitation

People with this illness are typically children who have difficulty absorbing new information. A lack of brain-ear connection is often to a fault. Even if a patient’s hearing is normal, an auditory processing problem might make it difficult to grasp what they hear. The paperwork must include the following items:

• To communicate, you must be able to move your body while speaking.
• The patient’s ability to generate and express themselves orally will assess by reading and understanding written material and employing good verbal communication.
• The ability to make speaking sounds will assess.
• Following the patient’s medical history, physicians do a physical examination that includes information on speech and language, hearing loss, and physical and mental development.

Speech and language evaluations may carry out. When deficiencies are detected, a treatment plan may develop for the patient. Speech therapy, hearing aids, and other options are available.

The assessment of speech fluency, including issues such as stuttering and cluttering, is central to this topic. The speech therapy CPT codes for this procedure is 92521. It is an essential medical code for speech therapists to know.

Before deciding on this CPT code, the physician uses quantitative and qualitative measures to determine the patient’s fluency level. SPM (Speaking Per Minute) is a unit of measurement for speaking speed (syllables per minute).

During the consultation, the healthcare professional documents the patients’ symptoms, including their severity, frequency, co-occurrence with other conditions, and the extent to which they are aware of and able to correct themselves.

Some CPT codes used by speech therapists are time-based and will calculate using Medicare time units. The standard notation for time-based CPT codes is as follows:

Additional SGD testing occurs every 30 minutes throughout the first hour of a speech-generating device (SGD) evaluation.

• Every hour, aphasia evaluations will complete.
• the first-hour evaluation of aural rehabilitation

Based on the medical documentation, time units may indicate in the chart below. Multiple coding represents the 15-minute limit for CPT codes that need face-to-face counseling.

Speech Therapy CPT Codes Description

Speech therapy CPT codes 92507, 92526, and 97535 can reimburse by the same provider in 15-minute increments for up to an hour per day. The following are some billing examples for treatment sessions:

• Is preparing the client for the session and documenting it.
• Services that will complete in less than eight minutes may not bill.

Every day, providers can bill for two codes relating to auditory rehabilitation: Speech therapy CPT codes 92630 and 92633. You will not be able to bill for speech therapy services on the same day as your evaluation.

To be reimbursed under the same procedure code every day, the physician must charge in 15-minute increments up to one hour. The following are some billing examples for treatment sessions:

• Is preparing the client for the session and documenting it.

Services that may complete in less than eight minutes may not bill. Every day, providers can bill for two codes relating to auditory rehabilitation: Speech therapy CPT codes 92630 and 92633.

According to the CPT manual, individual therapy for speech, language, voice, communication, and auditory processing impairments. To minimize ambiguity, the three service codes given in this section are not time-based and may only record once each session, regardless of how much time the practitioner spends with a patient.

It is unnecessary to record time increments because the code descriptor does not consider the time when determining which codes to utilize (e.g., every 15 minutes). Speech therapy CPT codes 92506, 92507, and 95008 may report only once per service day. 

Speech Therapy CPT Codes Billing Guidelines

Some time-based CPT codes used by speech therapists may calculate using Medicare time units. The standard notation for time-based CPT codes is as follows:

• Additional SGD testing occurs every 30 minutes throughout the first hour of a speech-generating device (SGD) evaluation.
• Every hour, aphasia evaluations will complete.
• the first-hour evaluation of aural rehabilitation
• Aural rehabilitation evaluations may extend by 15 minutes.
• Consider a patient’s medical record from a therapy session, for example. For argument, assume the healthcare provider spent 25 minutes face-to-face with the patient.

CPT 92507 covers anterior rhinoscopy, non-impacted cerumen removal, otoscopy, and non-impacted cerumen removal. E/M services do not usually comprise diagnostic or treatments.

If the paperwork does not support the service, CPT 92507 may usually refuse for medical reasons. The payer or insurance company will deny the claim if the condition may cause by an injury rather than a developmental concern.

NCCI only accepts payment for the first Speech therapy CPT codes after performing CPT 92507 in conjunction with the other two CPT codes, 97153 and 97155. Furthermore, the modifier is not allowed to provide these services.

When CPT 92507 (Auditory rehabilitation; postlingual hearing loss) and CPT 92630 (Auditory rehabilitation; prelingual hearing loss) may use together, both treatments will individually bill according to the NCCI.

If CPT 92507 may perform on the same day as Speech therapy CPT codes 92601-92604, modifier 59 will be applied (Programming cochlear implant). Physical and occupational therapists, non-physician practitioners (NPPs), and private practice physicians can give CPT 92507.

The clinician must use the modifier GN when providing service in an outpatient setting (CPT 92507). Children unable to communicate are ineligible for the CPT 92507 service; nevertheless, the system will self-correct in the future. 

If a doctor conducts many therapy sessions in a single day, each one will require a separate Medical Report. There should be no link between any treatments and previous doctor visits. Patients whose diseases have deteriorated to the point where they will not improve further cannot do exercises, drills, or therapies.

Chronic cough treatment is costly (92507). CPT 92507 will not utilize to bill for this service. It is also feasible that patients’ caregivers or family members will supply the necessary assistance if the 92507 CPT code is not required.

Speech Therapy CPT Codes Modifiers

Modifiers of forms -22 and -52 can emphasize how much the effort goes beyond what is generally necessary for such unusual activities. Modifier -22 may frequently use because the Medicare contractor may discover that the surgery resembles standard treatment delivery. 

Claims with the -22 modifier necessitate a more detailed explanation of why enhanced services are required. Timed codes cannot use with modifiers -22 or -52. The modifier -59 may distinguish one procedure from another invoiced on the same day only when authorized by the payer. 

The National Correct Coding Initiative lists changes that may need modifier -59. (CC). The -GN modifier requires Medicare Part B services for speech-language pathology and dysphagia. When billed as a Medicare Part-B service, the modifier GN will assign to CPT 92507 for SLP (Speech-language Therapy).

 The XK modifier may utilize if the physician certifies that the therapy will take longer than usual due to extraordinary circumstances, and medical proof may produce to support this service.

If CPT 92507 may utilize for a more extended period than is typical for speech therapy, the modifier 22 will be applied. When the patient’s current situation or other factors dictate a shorter service period, modifier 52 may add to the CPT 92507 service.

CPT 92507 does not contain any evaluation or management. According to NCCI, CPT code 92507 may include Modifier 59. Ninety-two thousand five hundred twenty-three can use to examine children’s speech and language ability. 

To employ 96125 and meet the abovementioned criteria, you must also thoroughly assess the child’s cognitive ability using standardized cognitive tests. 

The modifiers used for speech therapy CTP codes are C0,CR,GZ,GN,KX,59,55,22 and GA etc.

Speech Therapy CPT Codes Reimbursement

If the documentation allows it, a maximum of one 92507 CPT code can bill for this service. Outpatient clinics, community outpatient rehabilitation institutions, home health organizations, and hospices are among the facilities that provide services under CPT 92507. CPT 92507 cannot help us with modifiers 26 or TC. CPT 92507 costs and RUVS are as follows:

• The price is $85.46, and the RUVS code is 2.46950.

Speech Therapy CPT Codes Examples

The following are examples of when Speech Therapy CPT Codes may be used.

Example 1

Various measures may use to reduce self-orientation and disorientation. The therapist saw a 13-year-old child for assistance with memory and self-orientation. For 15 minutes, the therapist instructed the patient to repeat 15 words every 15 minutes. The patient could recall and speak six of the fifteen words with a few more tries. The therapist then asks the patient questions.

Example 2

As part of their therapeutic interactions, the therapist, for example, may inquire about the patient’s family background. The therapist observed a 15-year-old kid patient who couldn’t communicate. The patient became agitated and bewildered after being unable to talk for more than 15 seconds. 

With time, the patient gained the ability to talk more eloquently and articulate his thoughts—the patient exchanges storybooks to keep the lines of communication open. After repeated training sessions, the patient could speak for more than 20 seconds without becoming anxious. Ten-minute breaks separated each session. 

The therapist tests the patient by making him speak for more than 30 seconds. Following these training sessions, the patient could communicate for 25 seconds. The doctor’s office has scheduled an appointment for next week.