CPT code 92507, 92508, 92520, 92521, 92522 ; Speech Evaluation coding

Basics of CPT code 92507, 92508, 92520, 92521

In medical doing, their are separate set of procedure codes (CPT code 92507, 92508, 92520, 92521, 92522, 92523, 92524 & 92526) used for reporting evaluation and treatment of speech sound production, receptive language, and expressive language abilities, voice and resonance production, speech fluency, and swallowing.

Evaluations may include examination of speech sound production, articulatory movements of oral musculature, oral-pharyngeal swallowing function, qualitative analysis of voice and resonance, and measures of frequency, type, and duration of stuttering.

Evaluations may also include the patient’s ability to understand the meaning and intent of written and verbal expressions, as well as the appropriate formulation and utterance of expressive thought. Let us checkout the procedures codes used for these services one by one.

CPT code 92507 & 92508 should be used only for therapy services that address communication/cognitive impairments, voice prosthetics, and auditory rehabilitation.

CPT codes 92507, 92508, 92520, 92521, 92522, 92523, 92524, and 92526 are used to report evaluation and treatment of speech sound production, receptive language, and expressive language abilities, voice and resonance production, speech fluency, and swallowing.

Evaluations may include examination of speech sound production, articulatory movements of oral musculature, oral-pharyngeal swallowing function, qualitative analysis of voice and resonance, and measures of frequency, type, and duration of stuttering. Evaluations may also include the patient’s ability to understand the meaning and intent of written and verbal expressions, as well as the appropriate formulation and utterance of expressive thought.

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Description of CPT code 92507, 92508 , 92521, 92522, 92523 & 92524

A speech-language pathologist treats a speech, language, voice, communication, and/or auditory processing disorder. Using the information obtained from a separately reportable screening and in-depth evaluation of a speech or language disorder, the clinician develops an individualized treatment plan for the patient. The clinician defines specific treatment goals and sets baseline measures with which to assess the patient’s progress. These goals are continuously monitored and fine-tuned throughout the treatment period. Once the goals and baseline measures have been established the clinician uses a number of intervention activities to correct the specific speech or language disorder identified.

These can include games, stories, rhymes, drills, and other tasks. If the patient has a speech disorder, the clinician may demonstrate the sounds and have the patient copy the way the clinician moves the lips, mouth, and tongue to make the right sound. A mirror may be used so that the patient can practice making the sound while observing himself or herself in the mirror. Treatment of a language disorder might include help with grammar. If the patient is having difficulty with auditory processing, a game like Simon Says might be used to help improve understanding of verbal instructions.

CPT code 92507 is used for individual treatment of speech, language, voice, communication, and/or auditory processing disorder. CPT code 92508 is used when these services are provided to a group of two or more individuals.

92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual

92508 group, 2 or more individuals

Under direction of a physician, the patient undergoes developmental programs such as speech therapy, sign language, or lip reading instruction or hearing rehabilitation. In auditory processing disorders, the patient (usually a child) cannot process the information heard due to lack of integration between the ears and the brain, even though hearing may be normal. Central auditory processing disorder (CAPD) is often confused with or functions as an underlying factor to a number of learning disabilities. The treatment program is for the individual in 92507 or in a group setting in 92508

92521 Evaluation of speech fluency (eg, stuttering, cluttering)

92522 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria);

92523 with evaluation of language comprehension and expression (eg, receptive and expressive language)

92524 Behavioral and qualitative analysis of voice and resonance

The physician takes a patient history, including speech and language development, hearing loss, and physical and mental development, and a physical examination is performed. Speech and language evaluations are conducted. Assessment of any deficits is noted and a treatment plan for the patient is made that could involve speech therapy, hearing aids, etc.

In auditory processing disorders, the patient (usually children) cannot process the information heard due to a lack of integration between the ears and the brain, even though hearing may be normal. Central auditory processing disorder (CAPD) is often confused with, or functions as, an underlying factor to a number of learning disabilities.

For CPT code 92521, speech fluency, including stuttering and cluttering, is evaluated. Use CPT code 92522 when evaluation of phonics and speech/sound production is performed. Assign CPT code 92523 when language comprehension is addressed in addition to the evaluation in 92522. Use CPT code 92524 for evaluation of voice and resonance

92526 Treatment of swallowing dysfunction and/or oral function for feeding

The treatment of swallowing disorders is aimed at finding the specific cause of the dysfunction to treat the problem, such as anti-reflux medications to decrease stomach acidity or improve esophageal motility. Patients who have had strokes and cannot be treated surgically or by drugs for swallowing dysfunctions may require assistance from a rehabilitation specialist. In severe cases, the physician may elect to insert a feeding tube through the nose or in the stomach through the abdomen

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Medically Necessary Indications

Speech therapy is considered medically necessary for the treatment of communication disabilities and/or swallowing disorders (dysphagia) from disease when all of the following criteria are met:

• The member’s physician has determined that the member’s condition can improve significantly with speech therapy; and
• The speech therapy is expected to result in a significant improvement in the individual’s condition within a reasonable and generally predictable period of time; and
• Speech therapy services must be performed by a duly licensed and certified, if applicable, provider. All services provided must be within the applicable scope of practice for the provider in their licensed jurisdiction where the services are provided; and
• The speech therapy services provided must be of the complexity and nature to require that they are performed by a licensed speech-language pathologist or provided under their direct supervision by a licensed ancillary person as permitted under state laws; and
• Speech therapy services must be provided in accordance with an ongoing, written plan of care that is reviewed with and approved by the treating physician in accordance with applicable state laws and regulations. The plan of care should be of sufficient detail and include appropriate objective and subjective data to demonstrate the medical necessity of the proposed treatment (see appendix for documentation requirements). 

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Speech therapy is considered not medically necessary in the following circumstances:

• Duplicate therapy when members receive both occupational, physical and speech therapy; the therapies should provide different treatments and not duplicate the same treatment. When multiple therapies are used, each must have separate written treatment plans and must provide significantly different treatments and not be seen as generally duplicating each other.
• Maintenance programs such as drills, techniques, and exercises that preserve the member’s present level of function and prevent regression of that function do not meet Aetna’s contractual definition of medical necessity.  Maintenance begins when the therapeutic goals of a treatment plan have been achieved and when no further functional progress is apparent or expected to occur. Specifically, these include continued activities for individuals who have achieved generally accepted levels of function and are at a plateau or have reached “normal” levels. A plateau is a period of four weeks or dependent on the specific condition and/or individual situation, a lesser period of time that is seen as generally accepted;
• Speech therapy is unproven as a treatment for chronic cough;
• Treatments are not considered medically necessary if they do not require the skills of a qualified provider of speech therapy services, such as treatments that maintain function by using routine, repetitious, and reinforced procedures that are neither diagnostic nor therapeutic (e.g., practicing word drills for developmental articulation errors) or procedures that may be carried out effectively by the member, family, or caregivers at home on their own.

Non-Covered Indications for Speech Therapy for Children

• Speech therapy is considered not medically necessary for dysfunctions that are self-correcting, such as language therapy for young children with natural dysfluency or developmental articulation errors that are self-correcting.

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