CPT Code 92507 for Speech Therapy

CPT code 92507 is an important code used by speech-language pathologists (SLPs) for billing speech therapy services. This code applies specifically to the “Treatment of Speech, language, voice, communication, and/or auditory processing disorder; individual” session.

Key Takeaways:

• CPT code 92507 is owned by the American Medical Association and is required for billing speech therapy services to Medicare/Medicaid patients and many private insurance.
• Only SLPs can use 92507 for billing; audiologists cannot use this code.
• 92507 is a service-based code that should match the therapy procedure, regardless of session duration.
• Proper 92507 billing involves referring to the CPT manual, and documentation, and attaching the code to claims.
• Reimbursement rates vary, so SLPs must verify coverage and fee schedules.
• CPT codes like 92507 are updated annually on January 1st.

What is CPT Code 92507?

CPT, or Current Procedural Terminology, is a set of medical code used to report procedures and services to insurance companies. CPT codes are created and published by the American Medical Association (AMA).

CPT code 92507 specifically applies to the “Treatment of Speech, language, voice, communication, and/or auditory processing disorder; individual.” This code covers therapeutic services provided by speech-language pathologists to clients with communication disorders.

Coverage of CPT Code 92507

CPT code 92507 is required for billing speech therapy sessions to government-funded insurance programs like Medicare and Medicaid. It is also commonly accepted by private insurance companies when submitting claims for speech-language pathology services.

This code allows SLPs to receive reimbursement for treating disorders such as:

• Articulation disorders
• Phonological processing disorders
• Expressive and receptive language disorders
• Auditory processing disorders
• Voice disorders
• Fluency/stuttering disorders
• Tracheoesophageal voice restoration
• Communication modalities training

Using CPT Code 92507 for Billing

It is essential that SLPs use CPT code 92507 correctly on billing and insurance claims. Here are some key points:

• 92507 is a services-based code – It should be selected based on the service provided, not the time spent. Do not use 92507 for billing based on time increments.
• Only SLPs can use 92507 – This code is specifically for speech-language pathology services. Audiologists cannot use 92507 and have different CPT codes.
• Use the CPT manual for guidance – Refer to the code description in the most current CPT manual to ensure appropriate use.
• Match 92507 to the treatment – Choose 92507 when billing for a therapy session targeting speech, language, voice, communication or auditory processing disorders.
• Attach 92507 to the claim – Include the code with the billing submission or claim to the insurance provider.
• Check frequency limits – Only bill 92507 once per client per day. Don’t duplicate bills with 92507 for the same session.

Speech Therapy Documentation

Using CPT code 92507 also requires maintaining accurate documentation. SLPs should document details like:

• Client’s diagnosis
• Specific treatment activities performed
• Client’s response to treatment
• Progress made toward goals

Thorough speech therapy documentation is key to getting claims reimbursed when using 92507.

CPT Code 92507 Reimbursement Rates

The reimbursement rate for 92507 varies based on factors like:

• Type of insurance (Medicare, Medicaid, private)
• Individual insurance companies and plans
• Contracted provider agreements and fee schedules
• Geographic location where services are provided

On average, reimbursement for 92507 ranges from $15 to $175 per session. However, SLPs should always verify the reimbursement rate for 92507 with each specific insurance provider.

It’s also important to check frequently for reimbursement rate changes. Insurance providers adjust their fee schedules periodically.

Improving Reimbursement for CPT Code 92507

To maximize reimbursement potential with CPT code 92507:

• Confirm client insurance benefits – Get information on coverage, copays, limits, pre-approvals needed, etc.
• Verify reimbursement rates – Check fee schedules for exact payment rates from each payer.
• Use contracting & credentialing – Become an in-network provider for increased reimbursement.
• Appeal denials – Fight any claim denials when appropriate documentation is present.
• Consider outsourced billing – Let a professional billing service handle coding and collections.

2023 Updates to CPT Code 92507

The American Medical Association releases new CPT code books each year. CPT codes like 92507 are subject to updates, changes or deletions annually.

Changes typically take effect January 1st each year. SLPs should closely monitor annual CPT code updates and adjust their billing practices accordingly.

As of January 2023, no major changes have been made to CPT code 92507 or its description. SLPs can continue using 92507 as outlined in this guide.

However, it’s always advisable to re-check the latest CPT manual and verify with individual insurance providers that 92507 is still valid for speech therapy claims.

Stay up-to-date on any new edits or modifier requirements impacting 92507 and other speech-language pathology billing codes.

FAQs about CPT Code 92507

What is the covered diagnosis for 92507?

CPT code 92507 covers a wide variety of communication disorders. Appropriate diagnoses include articulation disorders, language disorders, phonological processing disorders, voice disorders, and auditory processing disorders. The client’s diagnosis should match the treatment when using 92507.

What is the difference between 92507 and 92526?

CPT code 92526 is for a diagnostic assessment, whereas 92507 is used for treatment sessions. SLPs would use 92526 for a speech/language evaluation and 92507 for ongoing therapy.

Can you bill 92507 for 60 minutes?

No, 92507 is a service code and cannot be billed based on timed increments. The typical therapy session is around 30-60 minutes but the exact time does not affect use of 92507.

How many units can you bill for 92507?

Providers can only bill for one unit of 92507 per client per day. You cannot bill multiple units of 92507 for one therapy session.

Can 92507 be used for groups?

No, 92507 is specifically for individual treatment. For group therapy, SLPs need to use a different code such as 92508.

Can SLPAs use code 92507?

No, only SLPs can bill services under 92507. Speech-language pathology assistants (SLPAs) cannot independently use CPT code 92507.

Conclusion

Understanding CPT code 92507 is essential for SLPs to receive proper reimbursement for speech therapy services. This code applies specifically to the individual treatment of speech, language and other communication disorders.

Key steps include verifying coverage, matching 92507 to the appropriate therapy service, documenting treatment, and confirming reimbursement rates. Careful use of 92507 along with correct billing procedures will help SLPs secure reimbursement and sustain their practice. Staying up-to-date on any changes to this important CPT billing code is highly advised.