92506 CPT Code: Evaluation of Speech, Language, Voice, Communication

CPT code 92506 is used to report an evaluation of speech, language, voice, communication, and/or auditory processing. This code is an important tool for speech-language pathologists and audiologists to receive reimbursement for their services.

Key takeaways:

• CPT code 92506 is used to report an evaluation of speech, language, voice, communication, and/or auditory processing
• It can be used by speech-language pathologists and audiologists
• The procedure involves assessing skills like speech sound production, language comprehension, vocabulary, and more
• Code 92506 cannot be billed on the same date of service as code 96105 for assessment of aphasia
• Typical reimbursement in 2022 is around $125 for the evaluation

CPT code 92506 falls under the range of codes used for diagnostic speech-language pathology and audiology services. Specifically, it is defined as:

Evaluation of speech, language, voice, communication, and/or auditory processing disorder; first hour

This code covers an extensive assessment that examines multiple areas of communication. The evaluation aims to determine if a communication disorder is present, provide a differential diagnosis, and guide treatment planning.

Areas Assessed Under 92506

Some key areas that may be evaluated under CPT code 92506 include:

• Speech sound production – Assessing articulation, phonology, apraxia, dysarthria, etc.
• Language comprehension and expression – Evaluating receptive and expressive language skills like vocabulary, grammar, syntax, etc.
• Voice and resonance – Examining vocal quality, pitch, loudness, resonance, etc.
• Fluency – Assessing presence of stuttering or cluttering.
• Hearing – Screening hearing to determine impact on communication.
• Oral mechanism – Evaluating structure and function of lips, jaw, tongue, palate, teeth, etc.
• Feeding and swallowing – Screening oral motor skills.
• Auditory processing – Assessing ability to interpret and respond to auditory information.

Not every area will be evaluated for every patient. The SLP or audiologist will tailor the assessment to the needs of each individual.

Billing and Coding Guidelines

To properly report 92506, clinicians should follow these billing guidelines:

• Time – 92506 is reported for the first hour of the speech-language evaluation only.
• Separate procedures – If the evaluation exceeds one hour, code 92507 can be reported for each additional 30 minutes.
• Same day services – 92506 cannot be billed on the same date as 96105 for aphasia evaluation.
• Ordering provider – The evaluation must be ordered by a physician or other qualified health provider.
• Documentation – Detailed documentation must substantiate medical necessity and be included in the patient’s medical record.

When coding an evaluation, the CPT code reported should reflect the typical time for performing the procedure. Even if the assessment goes slightly over or under the one hour time frame on a given day, 92506 is still the appropriate code to use for the first hour.

Medicare Reimbursement Rates

For context, the 2022 national average Medicare reimbursement rate for 92506 is around $125 according to the Physician Fee Schedule. However, the exact rate varies by location.

Here are some examples of reimbursement for 92506 in different areas:

• Los Angeles, CA – $144
• Chicago, IL – $126
• Houston, TX – $118
• Phoenix, AZ – $124
• New York, NY – $155

Keep in mind many other factors affect the final payment amount, including place of service, deductibles, cost sharing, and more. Private insurers will also establish their own fee schedules.

Examples of When to Use 92506

CPT code 92506 may be appropriately reported in these types of clinical scenarios:

• A pediatric SLP performs a comprehensive evaluation to assess a 5 year old with suspected language delay. Areas examined include receptive/expressive language, speech production, vocabulary, word retrieval, and more over a 55 minute session.
• An audiologist evaluates a 65 year old patient’s speech recognition and auditory processing skills to determine if a hearing aid is appropriate. Testing takes approximately 50 minutes.
• A geriatric SLP conducts a communication evaluation on an elderly patient with dementia who has recently experienced a decline in language skills. The 60 minute evaluation samples skills like vocabulary, comprehension, verbal fluency, functional communication, and cognitive-linguistic skills.
• A laryngectomy patient is evaluated by an SLP one month post-surgery. The SLP assesses areas like laryngeal voicing, tracheoesophageal speech, speech intelligibility, vocal quality, and resonance for 70 minutes.
• An SLP evaluates a teenager with a traumatic brain injury focusing on speech, language, cognitive communication, and swallowing skills over a 65 minute evaluation.

In each case, the speech-language pathologist or audiologist would report CPT code 92506 to describe the first hour spent performing the communication assessment.

Putting It All Together

In summary, CPT code 92506 is a key billing code used by speech-language pathologists and audiologists to receive reimbursement for performing comprehensive speech, language, and communication evaluations. This code covers the first hour spent assessing areas like speech sound production, language comprehension and expression, voice, fluency, hearing, oral mechanism, swallowing, and auditory processing skills. Code 92506 cannot be billed on the same date as CPT code 96105. With proper documentation, 92506 provides a mechanism for SLPs and audiologists to be compensated for their skilled assessments and allows patients to access these crucial services.