At first glance, navigating speech therapy billing can seem as complex as the vocal cords and speech patterns therapists work with. Busy daily routines of assessments, treatment sessions, and patient consultations mean that billing can get pushed down the priority list. Still, it’s paramount to the smooth running of a practice.
Accurate and efficient billing keeps the administrative side of your speech therapy practice humming along and ensures compliance with national regulations and guidelines. With billing errors and healthcare discrepancies becoming a significant issue, understanding billing codes has never been more crucial.
According to Gitnux MarketData, approximately 80% of medical bills have errors, with the majority (a shocking 63%) due to coding mistakes. Furthermore, over 50% of insurance rejections result from incorrect billing inputs.
Ensuring your billing is up to scratch isn’t just about numbers; it’s about sustaining your practice and compliance. We know – it can feel overwhelming!
That’s where Power Diary comes in.
Dive into our speech therapy CPT codes cheat sheet – we’ve worked hard to make codes and billing for speech therapy as straightforward as possible by covering everything you need to know about CPT and ICD-10 codes.
How Are CPT Codes & ICD-10 Codes Different?
CPT (Current Procedural Terminology) codes and ICD-10 (International Classification of Diseases, 10th Revision) codes are both essential in healthcare billing, and they serve distinct roles.
These codes are used hand-in-hand.
CPT Codes
CPT codes were developed by the American Medical Association (AMA). They define the specific intervention or treatment provided. – i.e. the service rendered.
CPT codes are displayed as a numerical sequence.
Here are a few examples:
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92609 Therapeutic service(s) for the use of speech-generating devices, including programming and modification
ICD-10 Codes
ICD-10 codes give voice to the reason behind the therapy. They name the specific conditions or disorders a client presents with, from stuttering to voice disorders.
ICD-10 codes are represented by a letter followed by numbers.
Here are some examples:
D14.1 Benign neoplasm of larynx
D38.0 Neoplasm of uncertain behavior of larynx
G46.0 Middle cerebral artery syndrome
Common CPT Codes for Speech Therapy Evaluation and Treatment
Here’s a list of the 19 most commonly used CPT codes for speech therapists.
31579 Laryngoscopy, flexible or rigid telescopic, with stroboscopy
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder
92520 Laryngeal function studies
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production
92523 With evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
97129 Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem-solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes
97130 Each additional 15 minutes of therapy, when appropriate
97533 Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands; each 15 minutes
92605 Evaluation for prescription of non-speech-generating augmentative and alternative communication device
92606 Therapeutic services for the use of non-speech-generating augmentation and alternative communication device
92609 Therapeutic services for the use of speech-generating device
92610 Evaluation of oral and pharyngeal swallowing function
31575 Laryngoscopy; flexible; diagnostic
31579 Laryngoscopy; flexible or rigid telescopic, with stroboscopy
92611 Motion fluoroscopic evaluation of swallowing function by cine or video recording
92612 Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording
CPT Code Modifiers Used in Speech Therapy Billing
Modifiers are added to CPT codes when a service or procedure has been altered due to an exceptional or mitigating circumstance.
Here are some common modifiers used:
-GN Used when Medicare Part B services are provided under plans of care for speech-language pathology.
-KX Used when the speech therapy professional attests that services at and above the therapy caps are medically necessary and reasonable. Justification is documented in the patient’s medical record.
-22 Used when the therapist believes the work required to provide a service is significantly greater than ordinarily required. Documentation must support this.
-52 Used when a service/procedure is partially reduced or eliminated at the therapist’s discretion.
-59 Used to identify procedures or services (excluding E/M services) that aren’t usually reported together.
Common ICD-10 Codes Used in Speech Therapy
The full list of ICD-10 codes used to describe speech and language pathology is extensive, but certain ICD-10 codes are applied more commonly than others in speech therapy practices.
Let’s look at the most common ICD-10 codes used by speech therapists:
F80.0 Phonological Disorder
Patients with this disorder have difficulty making the correct sounds for a letter or a word.
F80.1 Expressive Language Disorder
May involve impairments with language form, content, or use of Augmentative and Alternative Communication (AAC) for certain clients.
F80.2 Mixed Receptive-Expressive Language Disorder
Displayed when a patient has difficulty in expressing their feelings and thoughts and understanding what others are saying.
F80.81 Childhood-Onset Fluency Disorder
Characterized by the patient cluttering and stuttering.
R13.11 Dysphagia, Oral Phase
Difficulty swallowing. Swallowing may be associated with pain or may not be possible.
R13.12 Dysphagia, Oropharyngeal Phase
Patient has trouble swallowing and the issue involves the patient’s mouth and pharynx.
R48.8 Other Symbolic Dysfunctions
Used to capture language deficits as the first-listed diagnosis. It should only be used if an Audiologist has assigned the H93.25 code.
R47.1 Dysarthria and Anarthria
A speech deficit caused by issues with controlling the muscles involved with speech production. Anarthria is the most severe form, which results in the inability to produce articulate and clear speech. Vowel sounds, in particular, may be distorted.
R48.2 Apraxia
A neurological condition where the patient finds it difficult or impossible to move their mouth and tongue to speak. Not to be confused with aphasia, where the person’s inability to speak is due to a problem with understanding or using the words.
R63.3 Feeding Difficulties
May be used for difficulty clearing the mouth of residue, difficulty establishing feeding, dependency for feeding, chewing finding, and difficulty chewing.
R63.31 Acute Pediatric Feeding Disorder
Refers to a disorder that has been present for less than 3 months. Speech therapists working with children with a Pediatric Feeding Disorder may modify food or liquid textures.
R63.32 Chronic Pediatric Feeding Disorder
Refers to a disorder that has been present for more than 3 months
F80.4 Speech and Language Development Delay Due to Hearing Loss
Used for a developmental delay caused by hearing loss in children.
ICD-10 Codes & Power Diary
How to Use Diagnosis Codes in Power Diary
ICD-10 codes are pre-loaded into Power Diary, but it’s also possible to add your own diagnosis codes.
To add an ICD-10 code to a client’s profile, go to the menu on the left and navigate as follows:
- Go to People > Clients.
- Type the client’s name in the search bar. Once the name appears in the drop-down list, click on it to open their profile.
- In the second menu on the top-left corner inside the client’s profile, go to Records > Diagnoses.
- Click the + Add Diagnoses button.
- In the ‘Diagnosis Code’ field, type in your desired diagnosis code. Once you start typing, autocomplete suggestions will appear in a dropdown list. From here, you can click on the code you want to enter.
Using Diagnosis Codes with Superbills in Power Diary
If you want to display a client’s diagnosis in their Superbill, ensure you’ve selected the relevant diagnosis codes in all invoices for the client.
Here’s how:
- Go to People > Clients.
- Type the client’s name in the search bar. Once the name appears in the drop-down list, click on it to open their profile.
- In the second menu on the top-left corner inside the client’s profile, go to Billing > Invoices.
- Click on the invoice number to open it.
- In the ‘Invoice Items’ section, you’ll see a box labelled ‘Diagnosis’ next to each item/service. Enter your desired diagnosis code here.
- Once done, save the invoice. Repeat this process for all invoices you want to add to the client’s Superbill.
Now, you can generate a Superbill with the client’s diagnosis codes included.
Here’s how:
- Go to People > Clients.
- Type the client’s name in the search bar. Once the name appears in the drop-down list, click on it to open their profile.
- In the second menu on the top-left corner inside the client’s profile, go to Billing > Statements/Superbill.
- Click + Create Statement. Choose ‘Type’ as Superbill.
- Create the statement by populating fields as desired. Then click Create Statement to generate the Superbill.
For a step-by-step demo, watch this video.
Common Questions About Speech Therapy Billing Codes
What is The Code 92523 for Speech Therapy?
Code 92523 covers “evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language).”
The code should be used when using both formal and informal measures to evaluate speech and language skills. The evaluation may include language samples, speech samples, and standardised assessments.
What is CPT Code 92521 for Speech Therapy?
CPT code 92521: Evaluation of Speech Fluency. One of the most important CPT codes for speech therapists, CPT 92521 refers to the evaluation of speech fluency, specifically speech fluency disorders such as stuttering, cluttering, etc.
What is CPT Code 92526?
The CPT code 92526 description is Treatment of swallowing dysfunction and/or oral function for feeding. Speech therapists should use this CPT code when billing an individual treatment session for feeding therapy.
This is a service-based code (not time-based) and can only be billed once a day for treatments, not evaluation. It can be used on the same day as a Dysphagia evaluation, but it must be a separate service. In addition, there should be an existing Plan of Care and the treatment session billed under CPT code 92526 should address the goals stated in the Plan of Care.
The session should address the goals as outlined by the American Speech-Language-Hearing Association.
A speech therapist could use the code 92526 for treatment sessions that include:
- Improving oral function with an adult patient
- Addressing a pediatric patient’s oral Dysphagia
- Modifying a patient’s liquids to help with swallowing difficulties
- Making changes to the nipple of a bottle for a baby showing signs of Dysphagia
What is CPT Code 97130 for Speech Therapy?
This code is used for each additional 15 minutes. It should be listed separately in addition to the code you use for the primary procedure.
It should always be billed in conjunction with 97129 (which covers therapeutic interventions that focus on cognitive function and compensatory strategies.)
Can You Bill 92507 and 92526 Together?
Yes, but only one unit of each can be billed per treatment day. An exception to this is when the treatment plan is delivered twice a day based on a BID treatment order. In this event, you will bill for two units of 92507 and 92526.
What CPT Code Should I Use for Speech Therapy Evaluation and Treatment?
CPT code 92521 is used for the evaluation of speech fluency. As such, it is one of the most important medical codes for speech therapists.
What is Speech Therapy CPT 92508 Used For?
According to the American Speech-Language-Hearing Association, code 92508 is for the “treatment of speech, language, voice, communication and/or auditory processing disorder. It’s used for groups of two or more individuals.
What Is the ICD 10 Code for Speech Therapy?
The most commonly used speech therapy ICD-10 codes are:
- F80.0
- F80.1
- F80.2
- F80.81
- R13.11
- R13.12
- R48.8
- R47.1
- R48.2
- R63.3
- R63.31
- R63.32
- F80.4
Are ICD-10 Codes Updated?
Yes, ICD-10 codes are reviewed and updated every October.
You can find accurate updates on the latest speech therapy ICD-10 codes on the CMS website.
Are There New Codes For Speech Therapy in 2023?
In 2022, the R632.31 and R63.32 codes were added to the ICD-10 list.
For 2023, we don’t anticipate major changes to audiology- and speech-, language-, or pathology-related codes.
If anything, speech therapists may see amendments to other related diagnostic areas, including changes to diagnosis codes for dementia and mild cognitive impairment. These amendments will only be confirmed in October.
Streamline Codes and Billing for Speech Therapy In Power Diary
Make your life easier with Power Diary’s pre-programmed ICD-10 codes that make billing a breeze!
And that’s only the beginning of what Power Diary can do…
Features like online bookings and payments, automated appointment reminders, and much more are available at the click of a button to help you run your practice like a well-oiled machine.
So, if you want to increase efficiency and grow your practice, start your Free Trial today – no credit card required!
