CPT® Code 92507

Last Updated: January 2026 | Verified for 2026 AMA, CPT & CMS Guidelines

Quick Reference: CPT 92507

• Definition: Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual.
• Timing: Untimed code. Bill 1 unit per session regardless of length.
• Modifier: Requires modifier GN (Services delivered under an outpatient speech-language pathology plan of care).
• Medicare Rate: Approx. $76 (Non-facility national average).
• Diagnosis Linking: Must link to a specific communication disorder (e.g., R47.01 Aphasia, F80.2 Language Disorder).

CPT® 92507 is the primary procedure code used by Speech-Language Pathologists (SLPs) for individual therapeutic intervention. It covers a broad spectrum of services, including articulation therapy, voice therapy, cognitive-communication retraining, and auditory rehabilitation.

1. Scope and Indications for 92507

CPT 92507 is an all-encompassing code for individual treatment of communication disorders. It applies to:

• Speech Production: Articulation, phonology, apraxia of speech.
• Language: Receptive/Expressive deficits (e.g., Aphasia post-stroke).
• Voice: Dysphonia, vocal cord dysfunction, transgender voice therapy.
• Fluency: Stuttering or cluttering interventions.
• Cognitive-Communication: Memory, attention, and executive function retraining (e.g., TBI, Dementia).
• Auditory Rehabilitation: Treatment for auditory processing disorders (CAPD) or cochlear implant rehab.

2. Common ICD-10 Diagnosis Codes

Selecting the correct ICD-10 code establishes medical necessity. Common codes include:

3. Documentation Requirements and Medical Necessity

To support billing 92507, the medical record must include:

• Plan of Care (POC): Must be established by the SLP and certified (signed) by a physician/NPP within 30 days. Recertification is typically required every 90 days.
• Daily Note: Date, length of session (even though untimed), specific interventions used, and patient response/progress.
• Progress Reports: Periodic summary (e.g., every 10 visits) justifying continued need for skilled therapy.

Skilled Service Rule: Documentation must show that the service required the specific skills of an SLP. Repetitive drills that a caregiver could do are considered unskilled and are not reimbursable.

4. Medicare Billing Policies for CPT 92507

Therapy Threshold & KX Modifier

For 2026, the combined annual therapy threshold for PT and SLP services is $2,480. Action: Once a patient’s combined PT/SLP costs exceed $2,480, you must append the KX modifier to claims to attest that continued therapy is medically necessary. There is no hard “cap,” but claims above $3,000 may be subject to targeted medical review.

Required Modifiers

• GN: Required on ALL speech therapy claims (e.g., 92507-GN).
• KX: Required after exceeding the annual financial threshold.

flowchart TD
    A[Bill CPT 92507] --> B{Speech therapy service?}
    B -->|Yes| C[Append GN modifier]
    C --> D{PT/SLP costs > $2,480?}
    D -->|Yes| E[Append KX modifier: 92507-GN-KX]
    D -->|No| F[Bill as 92507-GN]
    E --> G{Claims > $3,000?}
    G -->|Yes| H[Prepare for targeted medical review]
    G -->|No| I[Submit claim]
    F --> I
    H --> I

5. Commercial Insurance Nuances (UHC, Aetna)

• Aetna: Considers speech therapy not medically necessary if it is duplicative or for “self-correcting” conditions. Often imposes a 60-day limit per condition.
• UnitedHealthcare (UHC): Often requires the GP modifier for all rehab therapies (PT/OT/ST) in their claims processing system, or explicitly GN. Always check the provider manual.
• Visit Limits: Many commercial plans have hard caps (e.g., 20 visits/year). Habilitative services (for developmental delays) may have separate limits from Rehabilitative services.

6. Proper Modifier Usage and NCCI Edits

Bundling Issues:

• 92507 + 97129 (Cognitive Therapy): NCCI edits generally prohibit billing speech therapy (92507) and cognitive intervention (97129) on the same day by the same provider. Medicare views cognitive work as integral to 92507.
• 92507 + 92508 (Group): Generally mutually exclusive for the same patient on the same day.
• Modifier 59 / XS: Use only if providing a distinctly separate service (e.g., Speech Therapy in the morning, separate Swallowing Therapy 92526 in the afternoon). Note that 92526 and 92507 do not always bundle, but distinct documentation is key.

7. Related Codes: 92507 vs 92508 vs 92523

8. Clinical Examples

Scenario 1: Post-Stroke Aphasia (Medicare)

Patient: 67yo male with expressive aphasia. Service: 45-minute session working on naming and word retrieval. Billing: 92507-GN (1 Unit). Diagnosis: I69.320. Note: If annual PT/SLP costs > $2,480, add KX modifier: 92507-GN-KX.

Scenario 2: Pediatric Articulation (Commercial)

Patient: 5yo female with phonological disorder. Service: 30-minute session for /r/ and /s/ sound correction. Billing: 92507-GN. Diagnosis: F80.0. Note: Check policy for habilitative visit limits (e.g., 30 visits/year).