Speech therapy CPT codes for SLP practices

For SLP practice owners and billers seeing children, adults or both: report evaluations by the area assessed (92521, 92522, 92523, 92524), individual treatment with untimed 92507 through December 31, 2026, and groups with 92508. Medicare needs GN on each line. On January 1, 2027, ten timed codes replace 92507.⁠^1,2,3,4

The American Medical Association owns and maintains CPT, and changes to the code set take effect each January 1.⁠^5,6 What follows is for education only: each claim is governed by the payer’s policy and by the CPT and HCPCS code sets in force on the date of service, and a question about one particular claim belongs with the payer or a certified coder.

Which CPT codes does a speech-language pathology practice bill?

A short list of evaluation, treatment, testing and cognitive codes, and the service actually delivered decides which goes on the claim. ASHA puts the order plainly: the patient’s clinical needs determine the length and content of the session, and coding rules then decide how it is reported.⁠⁷ Choose the code for what was done, never for what it pays. The codes do not change with age either: ASHA says SLPs code evaluation and treatment with the same CPT codes regardless of the patient’s diagnosis or age.⁠^1,8 What changes between a three-year-old and a seventy-year-old is the payer, with its code list, edits and authorization rules.

Most SLP codes are untimed and billed once per day; timed codes carry a time unit, such as per hour or each additional 30 minutes, in the descriptor.⁠³ CMS’s 2026 therapy code list sorts codes into always-therapy codes, which take a therapy modifier whoever performs them, and sometimes-therapy codes, which take it when a therapist furnishes them.⁠¹⁸

The last column comes from the Medicare practitioner edits in force from October 1, 2026; CMS revises the files every quarter, so read the current one before relying on a row.⁠¹¹ Past the year’s therapy threshold, KX joins GN on Medicare claims.

How do you choose among evaluation codes 92521, 92522, 92523 and 92524?

Code each disorder the evaluation actually covered: 92521 for fluency, such as stuttering or cluttering; 92522 for speech sound production alone; 92523 for speech sound production with receptive and expressive language; 92524 for a perceptual analysis of voice and resonance.⁠¹ Each is untimed; Medicare’s own example is 92521, one unit however many minutes it takes.⁠^2,3

ASHA’s answers: 92523 for a child’s speech and language evaluation, and 92523 with modifier 52 both for a language-only evaluation with no documented speech assessment and for an auditory processing evaluation.⁠¹ 92524 leaves out instrumental voice studies, which have their own codes such as 92520, and fitting a speaking valve or changing a tracheoesophageal prosthesis is 92597.⁠¹

More than one evaluation code can share a date when the patient was fully evaluated for more than one disorder. ASHA reads neither the CPT book nor the NCCI edits as preventing it, except for 92522 with 92523, and asks for documentation of a complete, distinct evaluation of each disorder, not a brief screen.⁠¹ The Medicare practitioner edits effective October 1, 2026 (2026 quarter 4, version 323) agree: 92523 with 92522 carries modifier indicator 0, so no modifier unbundles it, and it is the only edit among the four.⁠¹¹ The NCCI manual’s 2026 medicine chapter has no paragraph on these codes; the edit file is where the rule lives.⁠¹⁴ A hearing screening within the evaluation is not billable separately.⁠¹²

When is a speech-language re-evaluation billable under Medicare?

When something has changed and the record shows a need for more testing. CPT has no speech-language re-evaluation code, so Medicare has the evaluation code reported again, and it covers a formal re-evaluation only when the documentation supports further tests and measurements after the initial evaluation.⁠¹² Routine monthly retesting, the manual’s example being a Western Aphasia Battery during a rehabilitation program, is part of treatment.⁠¹² For other payers, read the re-evaluation policy before billing an evaluation code twice in one plan of care.

Which codes cover aphasia, cognitive and auditory evaluations?

Three timed families sit beside the evaluation codes: 96105 for a formal aphasia assessment and 96125 for standardized cognitive testing, each billed by the hour, and 92626 with its add-on 92627 for an auditory function evaluation tied to a surgically implanted hearing device.⁠^2,3,8

Medicare has 96105 reported in one-hour units for a formal instrument such as a full aphasia battery; test items used to track progress during treatment are part of the treatment unless a full, formal assessment is completed.⁠² CMS lists 96105 as sometimes therapy, so it takes GN when an SLP furnishes it.⁠¹⁸

For 96125, ASHA requires a standardized test, with the time to give it, interpret it and write the report reaching at least 31 minutes for the first hour and 91 for the second; screening tools do not qualify.⁠¹⁹ Billed the same day as 92521 to 92524, the documentation should explain why the cognitive evaluation was needed as well.⁠³ In the 2026 quarter 4 edits, each evaluation code paired with 96105 or 96125 allows a modifier, as does 96105 with 96125.⁠¹¹

92626 and 92627 were revised in 2020 and now describe an evaluation of auditory function for implant candidacy, or of speech understanding after an implant; ASHA says not to use them for anything unrelated to an implant, and the first hour needs at least 31 minutes face to face.⁠^3,8 Neither is on CMS’s 2026 therapy code list, so ask the Medicare contractor how it processes them from an SLP before billing.⁠¹⁸ Auditory rehabilitation treatment by an SLP goes to Medicare as 92507, not 92630 or 92633.⁠⁸

How are 92507 and 92508 billed for speech-language treatment?

As untimed codes, once per day each, whatever the session length: 92507 for individual treatment and 92508 for a group.⁠^3,9 The practitioner MUE for each is one unit per day in the table effective October 1, 2026, and CMS lists both as always-therapy codes that take GN.⁠^10,18 ASHA notes that training with and modifying voice prostheses is also reported with 92507.⁠³

The two are mutually exclusive in the NCCI file, 92508 in column one and 92507 in column two, with a modifier allowed; ASHA’s advice is to use such modifiers sparingly and only when clinically justified, as for a separate individual and group session on one date.⁠^11,20

How does an untimed SLP code differ from a timed 97-series code?

An untimed code is one unit per day; a timed 15-minute code is billed in units counted from the minutes. Under Medicare a single 15-minute code needs at least 8 minutes for one unit, and when several timed codes share a day, the total timed minutes decide the units.⁠² ASHA notes that Medicare’s 8-minute rule applies only to certain Part B therapy services, and that other payers may follow it, apply the CPT midpoint rule, or set their own.⁠⁷ The eight-minute rule guide works both methods through. So a half-hour 92507 session and an hour-long one each bill one unit, while 97129 and 97130 count minutes, as does every code replacing 92507 in 2027.⁠^4,9,19

What replaces CPT code 92507 on January 1, 2027?

Ten timed codes in five clinical categories, each with a base code for the first 30 minutes and an add-on for each further 15 minutes.⁠^4,21 ASHA’s page on the change, as it read on October 25, 2026, states the dates directly: "CPT code 92507 remains in effect through December 31, 2026. The new codes take effect January 1, 2027." It tells clinicians not to report the new codes early and to verify implementation with each payer, and says: "Other payers may decide if and when to implement the new codes into their fee schedules."⁠⁴

92508 stays the group code, revised to stand alone and still untimed.⁠^4,9 ASHA asks clinicians to choose the code that best describes the disorder treated, the services and the direct one-on-one time.⁠²¹

Medicare’s payment for the new codes is set in its 2027 fee schedule final rule.⁠⁴ In the proposed rule displayed July 14, 2026 (CMS-1848-P, comments closed September 14, 2026), CMS also proposed a pediatric speech-language pathology code, GSLPP, valued like 92507 and requiring 60 minutes of treatment personally performed by the billing clinician; ASHA says it did not request it.⁠^22,23 A proposed rule is not final, and Medicaid programs and commercial plans set their own payment policies.⁠²³

How are minutes counted under the new timed speech treatment codes?

By the payer’s rule; under the CPT midpoint convention as ASHA describes it, the base code is reportable from 16 minutes and the first add-on after the full 30 plus at least 8 more, so 16 to 37 minutes is one base code and 38 to 52 a base code and one add-on. ASHA adds that CPT instructions, CMS rules and payer policies may set different requirements.⁠²¹

Time on an untimed service, or a different timed service, does not count toward these codes, and the note should identify each service and the direct treatment time behind each code.⁠²¹ An add-on never goes out without its base code, and the separate speech sound and language codes are never reported together; a session treating both takes the combined 92660 and 92661.⁠²¹ Codes from different categories may share a date when each service is distinct, medically necessary and meets its own time, and they may go with swallowing codes when the record shows separate services; payer edits, MUE values for the new codes among them, may also affect same-day reporting.⁠²¹

How should an SLP practice prepare its payers for the new codes?

Ask every payer that pays 92507 the same questions in writing before January 1, 2027. ASHA says state Medicaid programs and commercial plans may adopt the codes on different timelines or set their own policies, that some may keep recognizing 92507 until their systems are updated, and that each payer’s effective date, coverage and prior authorization, billing and documentation expectations, and rates should be verified.⁠²⁴

1. List the payers. Every commercial, Medicaid, Medicaid managed care and Medicare Advantage plan that paid 92507 in 2026.
2. Ask four questions in writing. The start date; whether a 92507 authorization carries over; billing and documentation rules, including how minutes are counted; the rate for each base and add-on code. Record the answer, date and reference.
3. Rebuild the fee schedule and superbill. One line per base and add-on code, with 92508 kept for groups.
4. Change the note template. Capture direct minutes for each treatment category, apart from untimed services such as 92526.
5. Check each contract. A rate exhibit paying one rate per 92507 session needs prices for the new codes.
6. Bill by date of service. Sessions through December 31, 2026 as 92507; from January 1, 2027, the codes each payer has confirmed in writing.

Asking a plan for rates on the new codes is covered in the reimbursement rate guide.

When does an SLP report 97129 and 97130 instead of 92507?

When the treatment’s focus is primarily cognitive function, unless the payer instructs otherwise; when it is cognitive communication with language-based goals, 92507 may fit.⁠¹⁹ 97129 is the first 15 minutes, billed once per day, and 97130 each further 15 minutes, never without 97129.⁠¹⁹ CMS lists both as sometimes therapy, taking GN when an SLP furnishes them, and the MUE table effective October 1, 2026 allows one unit of 97129 and seven of 97130 per day.⁠^10,18

The same SLP cannot report both on one date. NCCI chapter 11 says a single practitioner shall not report 92507 or 92508 on the same date of service as 97129, 97130 or 97533, though a practice employing both kinds of practitioner may report an SLP’s 92507 and an occupational therapist’s 97129 with an NCCI-associated modifier.⁠¹⁴ The 2026 quarter 4 file carries the pair 92507 with 97129, indicator 1.⁠¹¹ The OT side of these codes is in the OT procedure codes guide.

Coverage varies more than for most SLP services: ASHA notes that many Medicare contractors’ local coverage determinations limit cognitive treatment to traumatic brain injury and stroke, and that no CPT code describes cognitive treatment in a group.⁠¹⁹ Read the contractor’s LCD or the plan’s policy before the first session, for a teenager after a concussion as much as for an adult after a stroke.

Which codes cover swallowing evaluations, studies and treatment?

92610 for a clinical swallowing evaluation, 92611 for the SLP’s work during a videofluoroscopic swallow study, 92612 for a complete endoscopic study (FEES), 92613 for interpreting and reporting one, and 92526 for treatment, which the 92526 feeding and swallowing guide covers in full.⁠³ ASHA notes that the radiologist reports 74230 for their part of the fluoroscopic study, that physician supervision for FEES varies by state, and that 92613 fits an SLP who interprets and reports but does not pass the scope, never billed with 92612.⁠³

CMS lists 92610, 92611 and 92612 as sometimes therapy, taking GN when an SLP furnishes them, and 92526 as always therapy.⁠¹⁸ The 2026 quarter 4 file puts 92610 in column two beside 92611, 92612 and 92613, so a clinical evaluation the same day as an instrumental study is denied unless a modifier fits a separate service; it has no edit pairing 92526 with 92610 or 92507.⁠¹¹ For 92526, the NCCI manual bars G0283 for electrical stimulation used during the treatment.⁠¹⁴

Medicare’s manual traces dysphagia mostly to neurological or structural impairments, from stroke and head and neck cancer to neuromuscular degenerative disease and dementia, and records the professional recommendation of a team setting with a physician or NPP supervising the radiological examination.⁠¹² Pediatric feeding is a service line of its own; how it differs from dysphagia, and who a payer lets bill 92526, are set out in adding a pediatric feeding and swallowing specialty.

Which codes apply to AAC evaluations and device treatment?

92607 for the first hour of a speech-generating device evaluation, 92608 for each further 30 minutes, and 92609 for treatment and programming for the device.⁠³ ASHA notes 92608 may cover an evaluation spanning several days, billed with 92607 under the last date of service; the MUE table effective October 1, 2026 allows four units of 92608 per day.⁠^3,10

For a non-speech-generating system, a communication board for instance, the codes are 92605 and 92618 for the evaluation and 92606 for treatment, and Medicare does not pay them separately: CMS’s 2026 list marks all three as bundled, and ASHA reports CMS’s position that these services are captured in whatever else the SLP provided that day.⁠^1,3,18 The practitioner MUE for 92605 and 92606 is zero.⁠¹⁰ For a Medicaid or commercial plan, check whether its fee schedule lists them before booking the evaluation.

The 2026 quarter 4 file edits 92607 against 92507, 92508, 92521 to 92524 and 92609 with a modifier allowed, and against 92597 with none; 92609 is edited against 92507, 92508 and the four evaluation codes, modifier allowed.⁠¹¹ A device evaluation and a speech-language evaluation on one date therefore need a record of two complete, distinct services before a modifier goes on.⁠^1,20 What a funder asks of the SLP’s evaluation for the device itself is in the AAC device funding guide.

Should an SLP bill group sessions with 92508 or with 97150?

With 92508. The NCCI manual says SLPs perform services coded 92507, 92508 or 92526, do not perform services coded 97110, 97112, 97150 or 97530, which physical or occupational therapists generally perform, and shall not report those codes as unbundled from 92507, 92508 or 92526.⁠¹⁴ The 2026 quarter 4 file edits 92508 against 97150, modifier allowed.⁠¹¹

What makes a session a group comes from Medicare’s manual: two or more patients seen simultaneously, who may be working on different activities, while the therapist stays present throughout without needing one-on-one contact; the paragraph covers all three disciplines and names 97150.⁠¹² ASHA adds that no CPT code describes group treatment for disorders outside 92508, dysphagia and cognition among them, that some local coverage determinations allow 97150 for those, and that a contractor may cap group size, at four patients in its example.⁠²⁵

Document why each patient was treated in a group, that the group sits within that patient’s own plan of care and serves the patient’s clinical needs, and the goals; ASHA rules out groups formed to suit the clinician or the facility.⁠²⁵ A pediatric social communication group and an adult aphasia conversation group are both 92508 sessions, each patient’s note carrying that patient’s goals and response.

Which modifiers belong on speech-language pathology claims?

For Medicare, GN on every line of service under a speech-language pathology plan of care; GO and GP mark occupational and physical therapy, and none lets anyone bill a service they are not qualified and recognized to perform.⁠^2,3 The others:

• KX: added past the year’s therapy threshold, below.⁠¹³
• 59, XE, XS, XP and XU: NCCI-associated modifiers marking a distinct service where an edit allows one; ASHA advises using them sparingly, only when clinically justified, and checking which one each payer wants.⁠²⁰
• 52 and 22: for an untimed service substantially shorter or longer than the code describes, sparingly and with documentation, never on timed codes.⁠^3,7
• CQ and CO: for services physical therapist and occupational therapy assistants furnish in whole or in part, paid at 85 percent; neither applies to speech-language pathology.⁠^2,13

Medicare also trims payment when several therapy services fall on one day: its multiple procedure payment reduction pays the service with the highest practice expense in full and 50 percent of the practice expense for each later always-therapy service that day, across disciplines.⁠^2,13

Can a speech-language pathology assistant’s services be billed?

Not to Medicare. Its manual says speech-language pathology assistants’ services are not recognized for Medicare coverage and are denied as not reasonable and necessary if billed as therapy, even where the state licenses the assistant; aides’ services are not covered either.⁠¹² CQ and CO exist only for physical therapist and occupational therapy assistants.⁠² For a Medicaid program or commercial plan, get its written policy on SLPA services before scheduling an assistant with its members, and keep the copy.

When does the KX modifier apply to speech therapy claims?

Once a patient’s PT and SLP services for the year together pass the 2026 threshold of $2,480, claims need KX to confirm the services are medically necessary as the record justifies, and claims above it without KX are denied.⁠¹³ PT and SLP share the one amount, so a patient’s physical therapy that year counts toward it; past $3,000 for the two, CMS’s targeted medical review may select claims, though not every one.⁠¹³ The threshold keeps the old cap amounts, but the caps themselves are repealed.⁠¹³ The patient’s side is in the Medicare therapy coverage guide, and Medicare enrollment for an SLP practice in the SLP practice guide.

How do NCCI edits affect same-day SLP evaluation and treatment?

They do not block it. Medicare’s manual says evaluation and treatment are both billable on the same day or at later visits, and the October 1, 2026 practitioner edits contain no pair of 92507 with any of 92521 to 92524.⁠^11,12 The claim still needs two services the record can tell apart: evaluation minutes are untimed, count in total treatment time, and are not also billed as treatment time.⁠¹²

Each edit names two codes: the first-column code is paid, the second-column code is refused unless a clinically appropriate NCCI-associated modifier accompanies it, and the modifier indicator says whether one may, 0 meaning never and 1 meaning allowed.⁠¹¹ CMS changes the files every quarter, so record the quarter checked against; and a missing edit does not make a pairing correct, as the NCCI manual reminds billers.⁠^11,14 The pairs an SLP practice meets most are in the edits column of the code map above.

What do medically unlikely edits limit for SLP codes?

The units of a code one provider can report for one patient on one date; for most untimed SLP codes the limit is one. CMS defines an MUE as the maximum units reported on the vast majority of appropriately reported claims by the same provider for the same patient on the same date, and not every code has one.⁠¹⁰ In the practitioner table effective October 1, 2026, 92507, 92508, 92521 to 92524, 92526, 92597, 92607, 92609, 92610 to 92613 and 97129 each have 1; 92608 has 4, 96105 has 3, 96125 has 2, 97130 has 7, and 92605 and 92606 have 0.⁠¹⁰

What documentation supports each SLP code family under Medicare?

A plan of care in place before treatment, its certification, progress reports, and a note for each treatment day. The SLP who provides the services may establish the plan, which must exist before treatment begins, and Medicare requires documentation for every treatment day and every therapy service.⁠¹²

• Certification: timely when a physician or NPP signs or verbally orders it, dated no later than 30 days after the first treatment day, evaluation included.⁠¹² The regulation sets recertification at 90 days or sooner and states that nothing in that paragraph creates an order or referral requirement for outpatient SLP services.⁠²⁶
• Evaluation: the disorders evaluated and the findings behind each code; when more than one evaluation code is billed, a complete, distinct evaluation of each disorder.⁠¹
• Progress report: written by the clinician, with a reporting period no longer than 10 treatment days.⁠¹²
• Treatment note: the date; each intervention, timed and untimed, in words matchable to the claim; total treatment time alongside total timed-code minutes; the clinician’s signature and professional identification.⁠¹²

For an untimed 92507 or 92526 session, Medicare’s manual asks that the total treatment time reflect the services billed as untimed codes; from 2027, the timed treatment codes add direct minutes for each code reported.⁠^12,21 Skilled care, not progress, is the test: coverage turns on the patient’s need for skilled care rather than the potential for improvement, and when a therapist’s skill is needed to design a maintenance program that holds function steady or slows its loss, that design is covered.⁠¹² For an adult with a progressive condition, the note should say what the clinician’s skill contributed.

How do pediatric SLP claims differ under Medicaid and EPSDT?

A child’s claim uses the same codes as an adult’s; what differs is who pays and by which rules. For a Medicaid enrollee under 21, EPSDT obliges the state to provide the Medicaid-coverable services a child medically needs to correct or ameliorate a health condition, and leaves medical necessity to the state, case by case.⁠²⁷ Letters of medical necessity, prior authorization and appeals for these children have their own guide, EPSDT coverage for pediatric OT, PT and speech therapy.

Read the state’s code list, not Medicare’s. Each state has to post its Medicaid fee-for-service fee schedule where the public can see it, listing children’s and adults’ rates apart when they are not the same, and that schedule shows which SLP codes the state pays.⁠¹⁵ States must apply Medicaid NCCI methodologies to fee-for-service claims, while applying them to managed care plans’ claims is optional, and Medicaid’s NCCI program differs significantly from Medicare’s; claim-specific edit questions go to the state Medicaid agency.⁠¹⁶ For 2027, ask the state program and each Medicaid managed care plan which codes it accepts from January 1, since ASHA says state Medicaid programs may adopt the new codes on their own timeline.⁠²⁴

A commercial plan’s policy decides which codes, modifiers and unit rules it follows; ASHA notes other payers may adopt the NCCI edits, and may follow Medicare’s 8-minute rule, the CPT midpoint rule or their own.⁠^7,20 Ask, and keep the written answer. Explaining these steps to a family is covered in the payment explanation guide.

Early intervention and school-based services run under other systems and are outside this page. Part C early intervention counts speech-language pathology among its services, delivered under public supervision and free to families unless federal or state law sets up family payments, and Part B treats speech-language pathology as a related service for students in special education.⁠^28,29 Send questions on either to the state’s early intervention program or the school district, and see working with IEP teams for a private practice’s part.

How do adult SLP claims work under Medicare Part B and Advantage?

Under Original Medicare, Part B claims go out under a certified plan of care, with GN on every line, KX past the threshold, and the current quarter’s NCCI and MUE edits applied.⁠^2,13,26 The adult conditions Medicare’s manual names include stroke with dysphagia, aphasia, apraxia or dysarthria; parkinsonism or multiple sclerosis with dysarthria, dysphagia or a voice disorder; and laryngectomy for laryngeal cancer.⁠¹²

After a stroke, one plan of care can carry swallowing, language and cognitive codes at once, each documented as its own service, with 97129 and 97130 only on days the same SLP does not bill 92507.⁠^3,14

Under 42 CFR 422.138, a Medicare Advantage plan’s prior authorization on basic benefits serves only two ends: confirming the diagnosis or other medical criteria a coverage decision rests on, and checking medical necessity against the standards in 422.101(c)(1). An approval given in advance binds the plan, which cannot later call the service medically unnecessary and can revisit the decision only for good cause or reliable evidence of fraud or similar fault.⁠¹⁷ Ask each plan how it counts authorizations: by visit, by unit or by date range.⁠²⁴

What does coding look like for one child and one adult patient?

Below, a child on Medicaid and an adult on Original Medicare, coded from the evaluation through the 2027 change.

Sources

1. American Speech-Language-Hearing Association. New CPT Evaluation Codes for SLPs (questions and answers on 92521 to 92524). Checked October 25, 2026.
   Show the passageHide the passage

   “Yes, SLPs may use these codes for any patient population, as long as they are the codes that are most descriptive of the evaluation being provided.”; “Neither the CPT Handbook or the National Correct Coding Initiatives (CCI) edits restrict an SLP’s ability to bill the new codes together because there are circumstances when it is appropriate for a patient to be evaluated for multiple disorders on the same day. The exception is the same-day billing of the combination of 92522 and 92523, which is restricted by both the CPT Handbook and CCI edits.”; “In cases where multiple evaluations may be appropriate, documentation should clearly reflect a complete and distinct evaluation for each disorder. Evaluation codes should not be billed for brief assessments that could be considered screenings.”; “If a patient is evaluated only for language, with no documentation of an assessment of speech (formal or informal), SLPs should bill 92523 with the -52 modifier”; “SLPs may bill an auditory processing disorder evaluation using CPT 92523 with a modifier -52 to indicate that a speech sound production evaluation has not been conducted.”; “No. There are separate codes for instrumental assessments, such as CPT 92520 for laryngeal function studies.”; “Both of these procedures should be coded using CPT 92597”; “When evaluating a child’s speech and language abilities, use 92523.”; “CMS made it clear that non-SGD services are considered “bundled” (i.e., not separately billable)”. The page lists the four codes as evaluations of speech fluency, of speech sound production, of speech sound production with language comprehension and expression, and a behavioral and qualitative analysis of voice and resonance. The 92597 answer is to the question whether 92524 may be used for fitting a speaking valve or changing a tracheoesophageal prosthesis.
2. Centers for Medicare & Medicaid Services. Medicare Claims Processing Manual, Chapter 5, Part B Outpatient Rehabilitation and CORF/OPT Services (Pub. 100-04, §§10.7, 20.1, 20.2 and 20.4). Checked October 25, 2026.
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   “The MPPR applies to all therapy services furnished to a patient on the same day, regardless of whether the services are provided in one therapy discipline or multiple disciplines, for example, physical therapy, occupational therapy, or speech-language pathology.”; “Full payment is made for the unit or procedure with the highest PE payment.”; “GN Services delivered under an outpatient speech-language pathology plan of care;”; “These modifiers do not allow a provider to deliver services that they are not qualified and recognized by Medicare to perform.”; “CMS has established two modifiers, CQ and CO, for services furnished in whole or in part by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs).”; “When reporting service units for HCPCS codes where the procedure is not defined by a specific timeframe (“untimed” HCPCS), the provider enters “1” in the field labeled units.”; “A beneficiary received a speech-language pathology evaluation represented by HCPCS “untimed” code 92521. Regardless of the number of minutes spent providing this service only one unit of service is appropriately billed on the same day.”; “For any single timed CPT code in the same day measured in 15 minute units, providers bill a single 15-minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes.”; “When more than one service represented by 15 minute timed codes is performed in a single day, the total number of minutes of service (as noted on the chart above) determines the number of timed units billed.”; “Providers report code 96105, assessment of aphasia with interpretation and report in 1-hour units.”; “It is common practice for regular assessment of a patient’s progress in therapy to be documented in the chart, and this may be done using test items taken from the formal examinations. This is considered to be part of the treatment and should not be billed as 96105 unless a full, formal assessment is completed.”.
3. American Speech-Language-Hearing Association. Medicare CPT Coding Rules for Speech-Language Pathology Services (coding guidance for Medicare Part B). Checked October 25, 2026.
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   “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.”; “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.”; “Modifiers -22 and -52 may not be used in conjunction with timed codes.”; “CMS requires that the “-GN” modifier be added to every code that is rendered under a speech-language pathology or dysphagia plan of treatment”; “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.”; “SLPs may also use 92507 to report auditory (aural) rehabilitation.”; “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.”; “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.”; “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.”; “92611 reflects the SLP’s work during the study. Radiologists separately report 74230 to report their participation in the study.”; “This is the complete endoscopic procedure. Level of physician supervision varies by state.”; “May be appropriate if SLP does not pass the scope but provides interpretation and report. Don’t bill in addition to 92612.”; “This is a timed code for each hour of testing.”; “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.”; “Revised in 2020. This is a timed code for the first hour of evaluation.”; “Code out of numerical sequence. This is an add-on code for 92605.”; “For Medicare, SLPs must use 92507 in lieu of this code”. The notes quoted are, in order, those on the time rules, modifiers, GN, 92507, 92597, 92605, 92608, 92611, 92612, 92613, 96105, 96125, 92626, 92618 and 92630. The page’s code table gives a first-hour time designation to 92605 and 92607, an each-additional-30-minutes designation to their add-ons 92618 and 92608, and a per-hour designation to 96105 and 96125; its descriptors for 92507, 92508, 92521, 92522, 92523, 92524, 92526, 92597, 92606, 92609, 92610, 92611 and 92612 carry no time designation.
4. American Speech-Language-Hearing Association. Speech-Language Pathology Treatment Codes Replacing 92507 (coding guidance, read on October 25, 2026). Checked October 25, 2026.
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   “CPT code 92507 remains in effect through December 31, 2026. The new codes take effect January 1, 2027. Clinicians should not report the new codes before their effective date and should verify implementation requirements with each payer, as they may vary.”; “replaced by a new family of 10 speech-language pathology treatment codes”; “The new codes describe individual treatment by clinical service and use a time-based structure consisting of a base and add-on codes.”; “Final Medicare values will be established in the CY 2027 MPFS final rule.”; “Other payers may decide if and when to implement the new codes into their fee schedules.”; “CPT code 92508 has been revised to be a stand-alone code for group treatment”. The page’s At a Glance table pairs each clinical service with a base code for the initial 30 minutes and an add-on code for each additional 15 minutes: fluency disorders, 92654 and +92655; speech sound production disorders, 92656 and +92657; language comprehension and expression disorders, 92658 and +92659; combined speech sound production and language disorders, 92660 and +92661; voice, upper airway dysfunction, and/or resonance disorders, 92662 and +92663.
5. American Speech-Language-Hearing Association. Current Procedural Terminology (CPT) Codes: Speech-Language Pathology (coding resource). Checked October 25, 2026.
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   “The CPT coding system describes how to report procedures or services and is maintained and copyrighted by the”; “American Medical Association.”; “Though coding and coverage policies can vary from payer-to-payer, there are general guidelines that should be considered.”; “speech-language pathologists should also contact payers for final coverage and coding decisions.”.
6. American Medical Association. The purpose of the CPT coding system and the CPT Editorial Panel (about the CPT code set). Checked October 25, 2026.
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   “is authorized by the AMA Board of Trustees to revise, update or modify CPT codes, descriptors, rules and guidelines.”; “The process is designed to adapt to technological advances by updating the CPT code set and related content annually with changes taking effect on Jan. 1 of each year.”; “The AMA first developed and published CPT in 1966.”.
7. American Speech-Language-Hearing Association. Understanding Timed and Untimed CPT Codes (coding guidance). Checked October 25, 2026.
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   “Untimed CPT codes are generally reported once per date of service, regardless of session length.”; “Medicare’s 8-minute rule applies only to certain Medicare Part B therapy services.”; “Clinical care comes first. The patient’s clinical needs should determine the length and content of the service. Coding and billing rules determine how the service is reported after it has been provided.”; “A 60-minute service reaches one reportable unit after 31 minutes have elapsed.”; “Other payers may follow Medicare’s rule, apply the CPT midpoint rule, or establish their own requirements.”; “These modifiers should be used sparingly and only when supported by clear documentation explaining the clinical circumstances that made the service unusually short or long.”; “Examples of underlying times for untimed codes include:”. The two examples given there are 92557 and 92610; the 31-minute passage sits under the page’s heading on the CPT midpoint rule.
8. American Speech-Language-Hearing Association. Coding and Payment for Aural Rehabilitation Services (coding guidance). Checked October 25, 2026.
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   “92626 and 92627 are now revised and more clearly defined to report an evaluation of auditory function to determine candidacy for a surgically implanted hearing device (e.g., cochlear implant, auditory osseointegrated implant) or for a post-surgical evaluation to document progress in speech understanding.”; “Do not use CPT codes 92626 and 92627 for activities unrelated to an implant”; “To bill the first unit (92626 base code), you must complete at least 31 minutes of face-to-face evaluation time.”; “Medicare is also clear that SLPs must use CPT code 92507 for auditory rehabilitation, instead of 92630 and 92633.”; “Audiologists and SLPs code for evaluation and treatment using the same CPT codes, regardless of the patient’s medical diagnosis or age.”.
9. American Speech-Language-Hearing Association. Background on Treatment Codes Replacing 92507 (coding guidance). “One broad, untimed code no longer provides the level of specificity expected under current CPT coding standards.”; “CPT code 92508 will remain available as a stand-alone, untimed code for group treatment of two or more individuals”. The first quotation describes 92507. Checked October 25, 2026.
10. Centers for Medicare & Medicaid Services. Medicare NCCI Medically Unlikely Edits (MUEs) (page last modified August 31, 2026, with the Practitioner Services MUE Table effective October 1, 2026). Checked October 25, 2026.
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    “An MUE is the maximum units of service (UOS) reported for a HCPCS/CPT code on the vast majority of appropriately reported claims by the same provider/supplier for the same beneficiary on the same date of service. Not all HCPCS/CPT codes have an MUE.”; “Practitioner Services MUE Table (ZIP) - Effective October 1, 2026; Posted September 1, 2026”. Practitioner services MUE values in the table: 92507, 92508, 92521, 92522, 92523, 92524, 92526, 92597, 92607, 92609, 92610, 92611, 92612, 92613, 92618, 92626, 97129 and 97150, 1 each; 92605 and 92606, 0; 92608, 4; 92627, 6; 96105, 3; 96125, 2; 97130, 7.
11. Centers for Medicare & Medicaid Services. Medicare NCCI Procedure to Procedure (PTP) Edits (page last modified September 1, 2026, with the Practitioner PTP Edits v323r0 for 2026 Quarter 4, effective October 1, 2026, file 4 (62292/01912 to U0003/U0004)). Checked October 25, 2026.
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    “If a provider reports the two codes of an edit pair for the same beneficiary on the same date of service, the Column One code is eligible for payment, but the Column Two code is denied unless a clinically appropriate NCCI PTP-associated modifier is also reported.”; “CMS posts changes to each of its NCCI PTP published edit files on a quarterly basis.”; “Modifier 0=not allowed 1=allowed”. Active edits in the file (column one, column two, modifier indicator): 92523/92522, 0; 92521, 92522, 92523 and 92524 each with 96105 and with 96125, 1; 96105/96125, 1; 92508/92507, 1 (mutually exclusive procedures); 92507 with 97110, 97112, 97129, 97150, 97530 and 97533, 1; 92507 with 97153 and 97155, 0; 92508 with 97129, 97150 and 97533, 1; 92526 with 97110, 97112, 97150 and 97530, 1; 92526/G0283, 0; 92607 with 92507, 92508, 92521, 92522, 92523, 92524 and 92609, 1; 92607/92597, 0; 92609 with 92507, 92508, 92521, 92522, 92523 and 92524, 1; 92611, 92612 and 92613 each with 92610, 1; 92612/92611 and 92613/92611, 1. Among 92521, 92522, 92523 and 92524 the only active edit is 92523/92522. The file has no active edit pairing 92507 with 92521, 92522, 92523, 92524, 92526 or 92610, or pairing 92526 with 92610.
12. Centers for Medicare & Medicaid Services. Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services (Pub. 100-02, Rev. 13889, issued July 30, 2026; §§220.1.2, 220.1.3, 220.2, 220.3, 230 and 230.3). Checked October 25, 2026.
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    “The plan, (also known as a plan of care or plan of treatment) must be established before treatment is begun.”; “The speech-language pathologist who will provide the speech-language pathology services.”; “The evaluation and treatment may occur and are both billable either on the same day or at subsequent visits.”; “Timely certification of the initial plan is met when physician/NPP certification of the plan is documented, by signature or verbal order, and dated in the 30 days following the first day of treatment (including evaluation).”; “Medicare coverage does not turn on the presence or absence of a beneficiary’s potential for improvement from the therapy, but rather on the beneficiary’s need for skilled care.”; “The goals of a maintenance program would be, for example, to maintain functional status or to prevent or slow further deterioration in function.”; “If the specialized skill, knowledge and judgment of a qualified therapist are required to establish or design a maintenance program to maintain the patient’s current condition or to prevent or slow further deterioration, the establishment or design of a maintenance program by a qualified therapist is covered.”; “The time spent in evaluation shall not also be billed as treatment time. Evaluation minutes are untimed and are part of the total treatment minutes, but minutes of evaluation shall not be included in the minutes for timed codes reported in the treatment notes.”; “A formal re-evaluation is covered only if the documentation supports the need for further tests and measurements after the initial evaluation.”; “Current Procedural Terminology does not define a re-evaluation code for speech-language pathology; use the evaluation code.”; “For Medicare payment purposes, information required in progress reports shall be written by a clinician”; “The minimum progress report period shall be at least once every 10 treatment days.”; “Documentation is required for every treatment day, and every therapy service.”; “Identification of each specific intervention/modality provided and billed, for both timed and untimed codes, in language that can be compared with the billing on the claim to verify correct coding.”; “Total timed code treatment minutes and total treatment time in minutes. Total treatment time includes the minutes for timed code treatment and untimed code treatment.”; “Signature and professional identification of the qualified professional who furnished or supervised the services”; “It is important that the total number of timed treatment minutes support the billing of units on the claim, and that the total treatment time reflects services billed as untimed codes.”; “Contractors pay for outpatient physical therapy services (which includes outpatient speech-language pathology services) and outpatient occupational therapy services provided simultaneously to two or more individuals by a practitioner as group therapy services (97150). The individuals can be, but need not be performing the same activity. The physician or therapist involved in group therapy services must be in constant attendance, but one-on-one patient contact is not required.”; “Services of speech-language pathology assistants are not recognized for Medicare coverage. Services provided by speech-language pathology assistants, even if they are licensed to provide services in their states, will be considered unskilled services and denied as not reasonable and necessary if they are billed as therapy services.”; “Services provided by aides, even if under the supervision of a therapist, are not therapy services and are not covered by Medicare.”; “monthly reevaluations; e.g., a Western Aphasia Battery, for a patient undergoing a rehabilitative speech-language pathology program, are considered a part of the treatment session and shall not be covered as a separate evaluation for billing purposes.”; “Although hearing screening by the speech-language pathologist may be part of an evaluation, it is not billable as a separate service.”; “Cerebrovascular disease such as cerebral vascular accidents presenting with dysphagia, aphasia/dysphasia, apraxia, and dysarthria;”; “Neurological disease such as Parkinsonism or Multiple Sclerosis with dysarthria, dysphagia, inadequate respiratory volume/control, or voice disorder; or”; “Laryngeal carcinoma requiring laryngectomy resulting in aphonia.”; “It is most often due to complex neurological and/or structural impairments including head and neck trauma, cerebrovascular accident, neuromuscular degenerative diseases, head and neck cancer, dementias, and encephalopathies.”; “Professional guidelines recommend that the service be provided in a team setting with a physician/NPP who provides supervision of the radiological examination and interpretation of medical conditions revealed in it.”.
13. Centers for Medicare & Medicaid Services. Therapy Services (page last modified March 10, 2026). Checked October 25, 2026.
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    “repeals application of the Medicare outpatient therapy caps and its exceptions process”; “the law preserves the former therapy cap amounts as thresholds above which claims must include the KX modifier as a confirmation that services are medically necessary as justified by appropriate documentation in the medical record.”; “there is one amount for PT and SLP services combined and a separate amount for OT services.”; “Claims for services over the KX modifier threshold amounts without the KX modifier are denied.”; “For CY 2026 this KX modifier threshold amount is:”; “$2,480 for PT and SLP services combined, and”; “the MR threshold is $3,000 for PT and SLP services and $3,000 for OT services. The targeted MR process means that not all claims exceeding the MR threshold amount are subject to review as they once were.”; “Medicare applies a MPPR to the practice expense component of certain “always therapy” services. Since April 1, 2013, the MPPR rate is 50 percent for both practitioner/office and institutional settings. It applies to the second and subsequent therapy services provided to a patient on the same day.”; “CQ modifier: PT services furnished in whole or in part by PTAs and”; “CO modifier: OT services furnished in whole or in part by OTAs.”; “Payment for these services is at 85 percent of the otherwise applicable PFS payment amount/rate for the service, effective January 1, 2022.”.
14. Centers for Medicare & Medicaid Services. National Correct Coding Initiative Policy Manual for Medicare Services, Chapter XI, Medicine, Evaluation and Management Services (revision date January 1, 2026; section H, Otorhinolaryngologic Services). Checked October 25, 2026.
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    “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 shall not report HCPCS/CPT codes 97110, 97112, 97150, 97530, as unbundled services included in the services coded as 92507, 92508, or 92526.”; “single practitioner shall not report CPT codes 92507”; “on the same date of service as CPT codes, 97129”; “However, if the 2 types of services are performed by different types of practitioners on the same date of service, they may be reported separately by a single billing entity.”; “a provider entity that employs both types of practitioners may report both services using an NCCI PTP-associated modifier.”; “shall not be reported with CPT code 92526 for electrical stimulation during the procedure.”; “Physicians are expected to code correctly even in the absence of NCCI PTP edits.”. Paragraph H.3 bars 92507 and/or 92508 on the same date as 97129, 97130 and/or 97533 for a single practitioner; paragraph H.4 concerns G0283 with 92526; the last quotation is from section P. The chapter has no paragraph on reporting 92521, 92522, 92523 or 92524 together.
15. 42 CFR. §447.203, Documentation of access to care and service payment rates (Medicaid; eCFR text as of October 22, 2026). Checked October 25, 2026.
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    “The State agency is required to publish all Medicaid fee-for-service fee schedule payment rates on a website that is accessible to the general public.”; “If the rates vary, the State must separately identify the Medicaid fee-for-service payment rates by population (pediatric and adult), provider type, and geographical location, as applicable.”.
16. Centers for Medicare & Medicaid Services. National Correct Coding Initiative (NCCI) in Medicaid (page last modified March 4, 2026). Checked October 25, 2026.
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    “The Medicaid NCCI methodologies must be applied to Medicaid fee-for-service (FFS) claims which are submitted with and reimbursed on the basis of Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes.”; “Application of NCCI methodologies to FFS claims processed by limited benefit plans or Managed Care Organizations (MCOs) is desirable but optional. The Medicaid NCCI program has significant differences from the Medicare NCCI program.”; “You must submit claim-specific inquiries to your State Medicaid Agency.”.
17. 42 CFR. §422.138, Prior authorization (Medicare Advantage; eCFR text as of October 22, 2026). Checked October 25, 2026.
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    “Prior authorization processes for coordinated care plans may only be used for one or more the following purposes:”; “To confirm the presence of diagnoses or other medical criteria that are the basis for coverage determinations for the specific item or service; or”; “For basic benefits, to ensure an item or service is medically necessary based on standards specified in § 422.101(c)(1), or”; “it may not deny coverage later on the basis of lack of medical necessity and may not reopen such a decision for any reason except for good cause (as provided at § 405.986 of this chapter and § 422.616) or if there is reliable evidence of fraud or similar fault per the reopening provisions at § 422.616.”.
18. Centers for Medicare & Medicaid Services. Annual Therapy Update (page last modified March 4, 2026, with its 2026 Therapy Code List and Dispositions, version 3). Checked October 25, 2026.
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    “The files on this web page contain the list of codes indicating whether they are sometimes or always therapy services.”; “These codes are “always therapy” services, regardless of who performs them. These codes always require a therapy modifier”; “to indicate that they’re furnished under a physical therapy, occupational therapy, or speech-language pathology plan of care, respectively.”; “These HCPCS/CPT codes represent “sometimes therapy” services. However, these codes are “always therapy” services”; “when furnished by a therapist and in this situation require the use of a therapy modifier”; “Regardless of whether they are billed alone or in conjunction with another therapy code, never make payment separately for these codes.”. The quotations are dispositions 5, 7 and 3. The 2026 list marks 92507, 92508, 92521, 92522, 92523, 92524, 92526, 92597, 92607, 92608, 92609, 96125 and 97150 with disposition 5 (92521 to 92524, 92597 and 92607 also with GN under disposition 9, the evaluation codes); 92605, 92606 and 92618 with dispositions 3 and 5; and 92610, 92611, 92612, 92614, 92616, 96105, 97129 and 97130 with disposition 7. Codes 92613, 92626 and 92627 do not appear on the list.
19. American Speech-Language-Hearing Association. Coding and Payment of Cognitive Evaluation and Treatment Services (considerations for speech-language pathologists). Checked October 25, 2026.
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    “CPT code 92507 (speech, language, voice, and communication treatment) may also be appropriate if the focus of treatment is cognitive communication and if treatment goals are language-based. However, if the focus of treatment is primarily cognitive function, SLPs should report 97129 and 97130 unless specifically instructed by the payer.”; “97129 represents the first 15 minutes of treatment and can only be billed once per day.”; “As an add-on code, 97130 must always be billed in conjunction with 97129 for each additional 15 minutes of therapy, when appropriate.”; “There is no CPT code to report cognitive treatment provided in a group setting.”; “Many LCDs limit cognitive treatment to TBI and stroke”; “SLPs should not use 96125 to report tests that are identified as a screening tool in the test description or that do not meet the time requirements described above.”; “at least 31 minutes to report the first hour, 91 minutes to report the second hour”.
20. American Speech-Language-Hearing Association. National Correct Coding Initiative (NCCI) System for Audiology and Speech-Language Pathology Services (coding guidance). Checked October 25, 2026.
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    “XE (separate encounter)”; “XS (separate organ/structure)”; “XP (separate practitioner)”; “XU (unusual, non-overlapping service)”; “Clinicians should use modifiers to bypass CCI edits sparingly, and only when clinically justified. Don’t append a modifier to a code pair solely to bypass a CCI edit if the clinical circumstances don’t justify its use.”; “Clinicians should also check directly with payers regarding modifiers for CCI edits.”; “Other third-party payers may also adopt CCI edits.”.
21. American Speech-Language-Hearing Association. Treatment Code Family Replacing 92507 (coding guidance on reporting the new codes). Checked October 25, 2026.
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    “Clinicians should select the code that most accurately describes the disorder or condition being treated, the services provided, and the amount of direct, one-on-one patient contact during the session.”; “The base code describes the initial 30 minutes, and the associated add-on code describes each additional 15 minutes. The add-on code may never be reported by itself and must be reported only with its designated base code.”; “Under the general CPT midpoint convention, clinicians may typically report the base code after they provide 16 minutes of the described service. Clinicians may typically report the first add-on unit after they provide the full 30-minute base period plus at least eight additional minutes. However, CPT instructions, CMS rules, and payer policies may establish different requirements.”; “The time associated with an untimed service or a different timed service cannot be counted toward the time used to report one of the new treatment codes.”; “Do not report the separate speech sound production and language codes together. When both areas are treated, use the combined speech and language code instead.”; “The new codes may also be reported with other timed or untimed codes outside this family, such as codes for swallowing-related services, when all requirements are met and the documentation supports that the services were separate and distinct.”; “More than one treatment code from the new family may be reported on the same date of service when each service is distinct, medically necessary, and independently meets its time requirement.”; “Documentation should identify the service performed and the direct treatment time associated with each reported code.”; “Medically Unlikely Edits (MUE) requirements (which should be announced during the last quarter of 2026), may also affect same-day reporting.”. Its reporting table, which applies when the CPT midpoint rule applies: less than 16 minutes, “Do not report the service separately”; 16–37 minutes, “1 base code”; 38–52 minutes, “1 base code + 1 corresponding add-on code”; 53–67 minutes, “1 base code + 2 units of the corresponding add-on code”; its group treatment table gives 92508’s time to report as “Untimed”.
22. Centers for Medicare & Medicaid Services. CMS-1848-P (the calendar year 2027 Physician Fee Schedule proposed rule’s notice page). Checked October 25, 2026.
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    “Regulation Type Proposed Rule”; “CY 2027 Payment Policies under the Medicare Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies”; “The proposed rule with comment went on display at the Office of the Federal Register’s Public Inspection Desk on July 14, 2026”; “The comment period will close on September 14, 2026.”.
23. American Speech-Language-Hearing Association. CMS Proposes Medicare Payment for New Speech-Language Pathology Treatment Codes (news, September 16, 2026, with updates from July 15, 2026). Checked October 25, 2026.
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    “CMS also proposed a new HCPCS code”; “for pediatric speech-language pathology services.”; “ASHA did not request this proposal, nor was it part of the AMA CPT development or valuation process.”; “CMS proposes valuing the G code by assigning it the same Medicare valuation as former CPT code 92507 (a process known as “crosswalking”) while requiring 60 minutes of personally performed treatment by the billing clinician.”; “The proposed rule is not final.”; “Medicaid programs and commercial health plans establish their own payment policies and are not required to adopt Medicare payment rates.”. The proposed code is named GSLPP in the article.
24. American Speech-Language-Hearing Association. Education and Implementation Resources for Treatment Codes Replacing 92507 (implementation guidance). Checked October 25, 2026.
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    “State Medicaid programs and commercial health plans may adopt the new codes on different timelines or establish their own coverage, payment, and billing policies. Some payers may continue to recognize CPT code 92507 until they update their fee schedules, coverage policies, and claims-processing systems.”; “Before reporting the new codes, SLPs should verify each payer’s requirements, including:”; “when the new codes become effective;”; “coverage and prior authorization requirements;”; “billing and documentation expectations; and”; “payment rates and fee schedules.”.
25. American Speech-Language-Hearing Association. Medicare Guidelines for Group Therapy: Speech-Language Pathology Services (Medicare guidance). Checked October 25, 2026.
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    “For example, a MAC could define group therapy as no more than four patients”; “identify why services were delivered in a group setting;”; “establish that group therapy services were provided as part of an individualized plan of care;”; “demonstrate that services were based on the clinical needs of the patient; and”; “Group therapy should never be provided for the convenience of the clinician or facility.”; “There are no CPT codes that describe group therapy for other disorders, such as dysphagia or cognition.”; “Some LCDs may also allow speech-language pathologists to use CPT code 97150”.
26. 42 CFR. §424.24, Requirements for medical and other health services furnished by providers under Medicare Part B (eCFR text as of October 22, 2026; paragraph (c)). Checked October 25, 2026.
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    “(ii) If the plan of treatment is established by a physical therapist, occupational therapist, or speech-language pathologist, the certification must be signed by a physician or by a nurse practitioner, clinical nurse specialist, or physician assistant who has knowledge of the case, except as specified in paragraph (c)(5) of this section.”; “Recertification is required at least every 90 days.”; “No references to an order or referral in this subsection shall be construed to require an order or referral for outpatient physical therapy, occupational therapy, or speech-language pathology services.”.
27. Medicaid.gov. Early and Periodic Screening, Diagnostic, and Treatment (benefit overview). Checked October 25, 2026.
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    “The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid.”; “States are required to furnish all 1905(a) Medicaid coverable, appropriate, and medically necessary services needed to correct and ameliorate health conditions, based on certain federal guidelines.”; “It is the responsibility of states to determine medical necessity on a case-by-case basis.”.
28. 34 CFR. §303.13, Early intervention services (IDEA Part C; eCFR text as of October 22, 2026). Checked October 25, 2026.
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    “Early intervention services means developmental services that”; “Are provided under public supervision;”; “Are provided at no cost, except, subject to §§ 303.520 and 303.521, where Federal or State law provides for a system of payments by families, including a schedule of sliding fees;”; “Speech-language pathology services include”.
29. 34 CFR. §300.34, Related services (IDEA Part B; eCFR text as of October 22, 2026). “Related services means transportation and such developmental, corrective, and other supportive services as are required to assist a child with a disability to benefit from special education, and includes speech-language pathology and audiology services”. Checked October 25, 2026.
30. DrSensory. DrSensory for therapists (the For Therapists hub). Checked October 24, 2026.
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    “DrSensory is a directory families use free to find occupational therapy, physical therapy and speech therapy clinics”; “across all 50 states and Washington, DC”; “Every clinic keeps a basic listing at no cost.”; “The directory lists clinics rather than individual therapists, so one listing covers a whole practice at one address.”; “Claiming is free and has three steps: find your listing, confirm your email with a six-digit code, choose a password.”; “There is no contract, and nothing is charged while you claim.”; “Therapy and developmental resources for children and adults, plus a directory of providers across the United States.”.
31. DrSensory. Therapy Clinic Directory Pricing (the pricing page and its frequently asked questions). Checked October 24, 2026.
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    “Outpatient physical therapy, occupational therapy, and speech-language pathology clinics. The directory lists clinics rather than individual therapists, so one listing covers your whole practice. Inpatient rehabilitation facilities and chiropractic practices are not listed.”; “$29.99 a month or $349.99 a year for your first location, and $9.99 a month or $99.99 a year for each additional location”; “Claiming your listing is free.”; “A description in your own words”; “We do not verify clinical quality”; “A listing means a practice appears in the directory. It is not a recommendation”; “Families never pay to search it or to contact a clinic”; “When a family writes from your profile, the address you gave for family inquiries is told that a message is waiting; you read it signed in, because what a parent writes about their child is health information, and you reply from your own address.”.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. It is general guidance on running a therapy practice, not legal, compliance, billing or financial advice. CPT codes belong to the American Medical Association; the code descriptions here are plain-language summaries, not the official descriptors.