Nine years ago, CPT code 92596 (evaluation of speech, language, voice, communication, and/or auditory processing) was eliminated, and four new codes took its place. However, given their complexity, we thought it would be advantageous to provide a quick and thorough refresher on all things speech therapy evaluation CPT codes. To help us out, we tapped our friend, Christina Britton, MS, CCC-SLP—owner of Eat, Talk & Play Therapy LLC.
Evaluation CPT Codes for Speech Language, Voice, and Cognition
Since 2009, private practice speech-language pathologists (SLPs) have been able to bill Medicare directly. Prior to that, SLPs were considered technical support—which changed how the RVU calculation applied to speech therapy CPT billing codes. With this change, the American Medical Association (AMA) and the American Speech-Language-Hearing Association (ASHA) collaborated to redefine a select number of speech therapy CPT codes. These new codes were intended to provide more accuracy and value to the work performed for reimbursement of the specific codes. ASHA has published a helpful guide to the 2023 physician fee schedule to better track and follow the RVUs for specific CPT codes.
(For some background on how RVUs affect the dollar amount you see from Medicare reimbursements, check out this blog post created by another one of our friends, Rick Gawenda.)
The codes that replaced 92596 are as follows:
While each individual code provides direction, it can still be a bit confusing to providers as every patient presents a different and unique challenge. To help pinpoint the best code for your practice, Britton told me that she uses 92523 most often, as it tends to provide for the most extensive and comprehensive testing to be done. She also shared that 92521 tends to have difficulty with insurance reimbursement as making the case for a stuttering impairment to be medically necessary can prove difficult, and 92522 is for articulation only. Lastly, she mentioned that 92524 is a code commonly used for speech therapists who specialize in voice disorders.
Evaluation CPT Codes for Swallowing Function
As we examine swallowing evaluation CPT codes, please note that not all SLPs perform swallowing evaluations and that some evaluation types require additional education and training. For the sake of brevity and clarity, we have listed the swallowing function codes below that are geared the most toward outpatient practice.
Of the codes referenced in the list above, 92610 is the only one that holds common outpatient clinical relevance where swallowing function is assessed without the use of any specialized equipment. The other four codes (92611, 92612, 92614, and 92616) require additional equipment and specialized training to complete and are used more widely in hospital settings. That said, Britton pointed out that 92610 can be combined with one of the other codes if the evaluating SLP has access to and the training for the specific tools.
Additional SLP Evaluation CPT Codes
We have covered the basics for language, voice, cognition, and swallowing—the more common reasons a person may seek speech-language pathology services. But here are four more CPT codes for speech therapy evaluations listed below that SLPs may need to know:
This code is most commonly used when fitting a patient with one of the listed oral devices, but the code also provides for use in situations without an actual fitting.
Starting January 1, 2020, CPT code 92626 was expanded to more clearly define and report on candidacy and evaluation of surgically implanted auditory devices. ASHA goes further to state that this code should not be used for auditory activities unrelated to an implant or in relation to hearing aids.
Starting in 2019, CPT code 96111 was deleted and replaced by 96112 to include memory and executive function. The CPT code 96113 was also created to denote additional time spent with the initial code of 96112.
This CPT evaluation code applies only to cognitive evaluations and places heavy emphasis on the use of a standardized test that is not deemed a screening tool. Additionally, ASHA goes further to state that if speech and language abilities are a dominant focus, then 92523 should be used instead as more than cognition alone is being evaluated.
Re-evaluations for Speech Therapy Services
As is often the case in rehab therapy, continuing a plan of care (POC) can necessitate a re-evaluation. Situations like a change in a patient’s status or continuing services beyond the initial POC require a re-evaluation to be completed. However, unlike PT and OT, there are no re-evaluation codes, so Gawenda recommends using the appropriate evaluation code that describes what you are re-evaluating.
Timed vs. Untimed Codes in Speech Therapy
Finally, we cannot discuss speech therapy CPT codes without also mentioning time vs. untimed CPT codes. Many speech therapy CPT codes are untimed—whether evaluative or treatment—which means these codes can only be billed once per day regardless if the therapist spent 30 minutes or 90 minutes on the specific evaluation or treatment code.
Conversely, other speech therapy CPT codes are timed with designations listed in each code’s definition. Examples of these descriptors include:
- per hour;
- first hour;
- initial 15 minutes; and
- each additional 30 minutes.
Speech therapists need to be aware of these specific codes and how to apply them in evaluations and subsequent treatment.
Well, there you have it—the most-commonly-used SLP evaluation CPT codes in outpatient settings. And while this resource will hopefully help guide any SLP in their evaluation efforts, it’s also good to have a documentation platform with embedded speech therapy workflows and billing codes for that extra peace of mind.