You submit a clean-looking claim on Tuesday morning. By Friday, it's bounced back. The reason? Almost always something fixable: a missing modifier, an ICD-10 that doesn't match, or a progress note that doesn't quite show medical necessity. And the code at the center of it is usually CPT code 92507.
It's the most-billed SLP treatment code in the country. It's also the one denied most often, and almost always for reasons that have nothing to do with the care provided. This guide walks through what CPT code 92507 covers, what Medicare pays for it in 2026, the modifiers your claims actually need, and the documentation habits that keep reimbursement moving instead of stalling. For the broader picture across all SLP codes, see our reference on speech therapy CPT codes.
What CPT Code 92507 Covers
The official description from the AMA is short: "Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual."1 In plain terms, this is the speech-language pathology treatment code for one-on-one therapy sessions.
You bill CPT 92507 when you're working directly with a single patient on goals tied to aphasia, dysarthria, fluency disorders, voice disorders, expressive or receptive language disorders, or auditory processing disorders. The "individual" part is doing real work in that definition. It means one clinician, one patient, one session.
What it's not for is just as important. Swallowing therapy goes under 92526, not 92507. Initial evaluations and re-evaluations use 92521 through 92524.2 AAC services have their own codes (92605–92609). And if you're running group therapy with two or more patients at once, that's 92508, not 92507.
A school-based SLP working with a seven-year-old on articulation? That's 92507. An outpatient SLP working with a stroke patient on word-finding? Also 92507. Same code, very different sessions, both correct.
How 92507 Is Billed: One Code Per Session, Period
Here's where SLPs working in multi-disciplinary clinics run into trouble. The 92507 CPT code is untimed. You bill one unit per session, no matter how long the session ran.3
That's a real shift if your billing department also handles physical therapy and occupational therapy, where most codes are billed in 15-minute units. A 60-minute PT session might be four units. A 60-minute SLP session is one unit. Same chair, same hour, totally different math.
The session length doesn't matter as long as the session was skilled and medically necessary. A focused 25-minute push-in session counts as one unit. So does a 55-minute session in the clinic. So does a 45-minute session over telehealth.
And you can only bill 92507 once per patient per day. A school-based SLP who pulls a student out twice in one day for two short sessions still bills one unit, not two. The narrow exception is when you're providing a distinctly separate service the same day, and even then the documentation has to clearly support it (more on modifier 59 below).
2026 Reimbursement Rates and the KX Threshold
The 2026 Medicare non-facility rate for CPT code 92507 is approximately $85.53, up roughly 2% from the 2025 rate of about $84.4 That's the national average. Your actual rate depends on geographic locality, so confirm with your Medicare Administrative Contractor if you want the number for your area.
One detail worth knowing: 92507 is exempt from the 2.5% efficiency adjustment that pulled down some other codes in the 2026 Medicare Physician Fee Schedule.4 So while a few SLP codes took a small hit, 92507 didn't.
The other 2026 number to know is the therapy threshold: $2,480 combined for PT and SLP services per beneficiary.5 Once a patient's cumulative therapy spend crosses that line, every 92507 claim needs the KX modifier appended to confirm continued medical necessity.
The math sneaks up on practices that aren't watching it. A private practice patient seen four times a week hits the threshold in about seven weeks. If your billing team doesn't have a system for catching that moment, the first denial is how you find out. Commercial payers usually pay above Medicare for 92507, and Medicaid varies dramatically by state, so the threshold and modifier rules really matter most when you're billing Medicare Part B.
Modifiers SLPs Actually Need to Know
If there's one place 92507 claims die, it's the modifier line. A few you'll see constantly:
GN is required on every Medicare Part B SLP claim. It identifies the service as part of a speech-language pathology plan of care. Miss it once, and the claim doesn't even reach a medical-necessity review. It dies at intake. Missing GN is one of the most common SLP claim denial causes.3
KX is the one tied to the $2,480 therapy threshold. Once your patient is past it, every 92507 claim needs KX appended to confirm services remain medically necessary and that the documentation supports it.5
59 is for distinctly separate services on the same day, like 92507 in the morning and 92526 (swallowing therapy) in the afternoon. Use it only when the services are genuinely separate and the notes show it. Overusing modifier 59 is one of the fastest ways to land in an audit.3
95 is the telehealth modifier for synchronous audio-visual sessions.
And then there are the discipline mix-ups that catch multi-disciplinary clinics. GP is for physical therapy. GO is for occupational therapy. GN is for SLP. Mixing them up on a claim is common when one billing team handles all three, and it's an automatic denial every time.
Put it together: a Medicare claim for an 80-year-old patient past the therapy threshold getting individual speech therapy might look like 92507, GN, KX. Without GN, the claim never makes it past intake.
Documentation That Gets 92507 Paid
Modifiers are the visible part of the claim. Documentation is what actually keeps the claim paid when someone looks closely.
Medicare requires a progress report every 10 treatment days or 30 calendar days, whichever comes first.2 Each individual session note should show:
- The skilled SLP intervention you provided
- The patient's response
- Progress toward measurable, functional goals
- Any plan adjustments based on what you saw
A note that says "worked on articulation, patient cooperative" won't survive an audit. Goals, baselines, and progress have to be visible in the chart. If your team needs a refresher on what a defensible session note looks like, our guide to SOAP notes for speech therapy walks through the structure. So does the link between the CPT code and the ICD-10 diagnosis. 92507 lines up cleanly with R47.01 (aphasia), F80.0 (articulation disorder), or R49.0 (voice disturbance). It does not line up with R13.10 (dysphagia), which belongs to 92526. That mismatch is one of the quieter, more frustrating denial sources because it looks like a clean claim until someone reviews it.
The supervision piece matters a lot in teaching settings. Under Medicare Part B in a university speech-language clinic, student clinicians cannot bill independently. A graduate student in a university clinic needs the supervising SLP to review and sign the documentation, and the supervision arrangement has to be reflected in the note. The same is true (in a different way) for a Clinical Fellow in a private practice billing under their supervising SLP. The rules aren't identical, and the documentation has to match the actual supervision being provided.
This is the moment good speech therapy documentation software earns its keep. When CPT codes, ICD-10 codes, progress notes, and supervisor sign-off all live in one place, the medical-necessity story writes itself instead of having to be reconstructed after a denial.
Common 92507 Denials and How to Prevent Them
Most 92507 denials trace back to the same handful of issues. Knowing the list is most of the fix:
- Missing the GN modifier on a Medicare Part B claim
- CPT-ICD-10 mismatch, most often billing 92507 with a dysphagia diagnosis
- Using an evaluation code (92521–92524) for a follow-up treatment session
- Missing or expired prior authorization for payers that require it before treatment starts
- Documentation that doesn't show skilled care or measurable progress toward goals
- Billing more than one unit of 92507 per patient per day without a valid distinct-service reason
The practical fix is a short pre-submission checklist baked into your billing workflow. Modifier present? ICD-10 matches the CPT? Progress note signed and dated? Authorization current? It's five seconds per claim and prevents the bulk of preventable denials. If you want a deeper look at what else trips SLP claims up, common SLP billing mistakes covers the patterns we see most.
Getting 92507 Right Without Making It a Second Job
CPT code 92507 is easy to bill correctly once you know the rules and easy to fumble when you don't. Untimed. Individual. GN on every Medicare claim. KX above the $2,480 threshold. Documentation that shows medical necessity and ties cleanly to the right ICD-10. That's the whole job.
Most 92507 denials don't come from clinical decisions. They come from missing modifiers and thin documentation, both of which are fixable inside your daily charting routine, not after the fact.
Need a system that keeps documentation, CPT codes, and modifiers connected in one place? ClinicNote is the EMR speech clinics use to make billing 92507 a routine part of the note, not a separate scramble at the end of the week. Get a demo and see how it fits your clinic.
Sources
- https://www.asha.org/practice/reimbursement/coding/slpcpt/
- https://www.asha.org/practice/reimbursement/medicare/slpcodingrules/
- https://www.sprypt.com/cpt-codes/92507
- https://www.asha.org/siteassets/reimbursement/2026-medicare-fee-schedule-for-speech-language-pathologists.pdf
- https://www.asha.org/news/2026/update-on-cpt-code-92507-valuation-review-underway/
- https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleID=54111
- https://www.simplepractice.com/resource/cpt-code-92507/