Speech Evaluation CPT Codes: 92521, 92522, 92523 and 92524

92522 reports an evaluation of speech sound production alone. 92523 reports that same speech sound evaluation combined with an evaluation of language comprehension and expression, so it is the code for a full speech and language evaluation. ASHA states that 92522 is already included as part of 92523, which is why you may only bill one or the other for the same evaluation.

ASHA's Medicare fee schedule analysis carries the same note on both codes: do not bill 92522 in conjunction with 92523. ASHA's table of Medicare correct coding edits lists the 92523 and 92522 pair as one that cannot be bypassed with a modifier, but edits are updated every quarter, so confirm the current NCCI table before billing.

ASHA explains that a language-only evaluation can be reported as 92523 with modifier 52, which marks a service that was reduced compared with the full description. ASHA's Medicare coding rules say the same: for an evaluation of language only, apply modifier 52. If the clinician documents clinical judgment about speech, even if speech was assessed informally, ASHA says billing 92523 without modifier 52 is appropriate.

ASHA also directs auditory processing evaluations to 92523 with modifier 52, to show that a speech sound production evaluation was not conducted. Auditory processing treatment falls under 92507.

The evaluation codes are not 15-minute timed codes. None of the descriptors ASHA lists for 92521 to 92524 includes a time period, ASHA identifies 92524 as untimed, and ASHA notes that most speech-language pathology codes are untimed, service-based codes. CMS says an untimed code, with 92521 as its example, is reported with one unit regardless of the minutes spent.

The Medicare 8-minute rule therefore does not apply to these codes. It only counts minutes for 15-minute timed codes. See the 8-minute rule calculator for how timed codes are counted.

ASHA notes that when the codes were introduced, neither the CPT Handbook nor the Medicare correct coding edits restricted billing the new codes together in general, since a client may be evaluated for several disorders on one day. The exception is 92522 with 92523. ASHA also notes that the time for identifying other disorders is already built into the value of each code.

That guidance dates from the 2014 introduction, so check the current NCCI tables and each payer's policy for the pairs you plan to bill. Some combinations with other codes require modifier 59, and ASHA points to its correct coding edit tables for the details.

92524 is a behavior-based assessment of voice quality and resonance. ASHA states that it does not include instrumental assessment, which has separate codes, such as 92520 for laryngeal function studies. ASHA also notes that speaking valve and tracheoesophageal prosthesis changes are not coded with 92524.

92526 is treatment of swallowing problems or oral function for feeding. It is not part of the 92521 to 92524 family and does not evaluate speech or language. When swallowing is evaluated, the code is 92610, and 92526 reports the treatment that follows.

Evaluations and treatment are documented separately. For speech and language treatment, 92507 remains valid through December 31, 2026. See the 92507 guide for the 2027 changes.

ASHA states that Medicare requires modifier GN on every code rendered under a speech-language pathology or dysphagia plan of treatment. CMS article A52866 says that CPT does not define a speech-language pathology re-evaluation code, so a re-evaluation is reported with the evaluation code, and it describes re-evaluation as not a routine, recurring service.