You open an intake for tomorrow morning and the referral lists three things: fluency concerns, articulation, and "maybe some language." You've got 90 minutes. You're trying to figure out, before the patient walks in, which evaluation code (or codes) you're going to bill at the end of it.
If that scene feels familiar, you're not alone. Speech therapy evaluation CPT codes aren't a single code. They're 13 codes spread across five categories, three timing models, and a same-day pairing matrix that nobody keeps in their head perfectly. Most denials in this space aren't bad clinical work. They're code selection mistakes the documentation never had a chance to defend.
This guide walks through the full set of speech therapy evaluation CPT codes, the decision rules that pick the right one, the same-day pairings that work (and the ones that don't), and the documentation that holds up if an auditor asks why you billed what you billed. It's written for working SLPs, CFs, supervisors, grad students, and billing staff across private practice, university clinics, school-based settings, and hospitals.
The Full Set of SLP Evaluation CPT Codes at a Glance
Here's the lay of the land. SLP evaluation breaks into five categories:
- Speech sound, language, fluency, and voice (92521, 92522, 92523, 92524) — untimed, service-based.
- Swallowing (92610, 92611, 92612, 92614, 92616) — clinical and instrumental, untimed.
- AAC evaluation (92607, 92608) — time-based, first hour plus 30-minute add-on units.
- Aphasia assessment (96105) — per hour, includes scoring and report time.
- Cognitive performance testing (96125) — per hour, includes scoring and report time.
Treatment codes (92507 for individual treatment, 92526 for swallowing therapy, 92609 for AAC therapy) sit on a different side of the fee schedule and aren't covered here. For the most-used treatment code, see our CPT code 92507 guide.
The three timing models matter more than most clinicians realize:
- Untimed. 92521 through 92524 and 92610 through 92616. Bill once per evaluation, no matter the session length.
- Per hour, including report time. 96105 and 96125. The hour includes test administration, scoring, and report writing.
- First hour plus 30-minute add-on units. 92607 and 92608. Time-stamps required.
Mixing these models is one of the top sources of unit-count denials.1 A 25-minute language eval and a 90-minute language eval are both one unit of 92523. A 90-minute cognitive performance battery (with another 45 minutes of scoring and report writing) is two hours of 96125. Different rules, same family.
2026 is a quiet year for SLP evaluation codes. No new evaluation codes were added, none were deleted, and the new 2.5% efficiency adjustment that hit some 2026 codes doesn't apply to this set.2 The 2026 RTM additions (98979, 98984, 98985, 98986) are real, but they don't affect evaluation billing.
Picking Between 92521, 92522, 92523, and 92524
Four codes, one decision rule:
- 92521 evaluates fluency. Stuttering, cluttering, and disfluency-based disorders.
- 92522 evaluates speech sound production only. Articulation, phonology, apraxia, dysarthria.
- 92523 evaluates speech sound production plus language comprehension and expression. It includes everything 92522 does, with the language piece on top.
- 92524 is a behavioral and qualitative analysis of voice and resonance.3
The rule that decides every code selection in this set: the code reflects what you actually assessed and documented, not the referring diagnosis.
The 92522 vs. 92523 trap is where the most money gets lost and the most money gets clawed back. 92523 already contains 92522. The CPT manual and the National Correct Coding Initiative bundle them, and reporting both on the same date triggers an automatic denial.4 Defaulting to 92523 because it sounds more comprehensive (when language wasn't actually tested) is overbilling. Billing 92522 when you also administered a PLS-5 or CELF-5 is undercoding the work you did.
One useful guardrail: Modifier 52 (Reduced Services). If a 92523 evaluation starts but only the speech sound portion gets completed (the kid melts down, the parent has to leave, you run out of time), don't bill the full 92523. Append Modifier 52 to signal the service was reduced.3
Same-day pairings allowed across this set: 92521 + 92523 (fluency and a separate speech-language eval), 92521 + 92524 (fluency and voice). Each has to stand as its own complete evaluation in the note. 92522 + 92523 is the one combination that's prohibited.
A quick example. A pediatric SLP evaluates a 4-year-old referred for "speech delay." Articulation testing only, no language battery. That's 92522. Bring the child back next week for the PLS-5 and you can't retroactively turn it into 92523, because the speech sound piece was already billed. Different code, different visit, different documentation.
For the full decision walkthrough on these four codes, see our CPT 92521-92524 guide.
Dysphagia Evaluation Codes: 92610, 92611, 92612, 92614, 92616
The swallowing evaluation set covers a wider range of clinical settings than the rest of the eval family, so the code you pick depends as much on the equipment in front of you as the patient on the table.
- 92610. Clinical, bedside evaluation of oral and pharyngeal swallowing function. The most common dysphagia eval in outpatient and school settings.
- 92611. The SLP's role in a modified barium swallow study (MBSS or videofluoroscopy). The radiologist bills 74230 separately for the imaging side.
- 92612. Flexible fiberoptic endoscopic evaluation of swallowing (FEES). Requires equipment and specialized SLP training.
- 92614. Flexible fiberoptic endoscopic laryngeal sensory testing on its own (without the swallowing assessment).
- 92616. FEES plus laryngeal sensory testing combined, sometimes called FEEST. When both are performed in the same session, bill 92616, not 92612 and 92614 stacked.5
When does 92610 fit versus the instrumental codes? 92610 is the clinical exam in any setting. The instrumental codes (92611, 92612, 92616) typically happen in hospitals, ENT clinics, or specialized SLP settings where the equipment lives.6
Two same-day rules worth keeping front of mind. 92610 and 92611 can't be billed in duplicate on the same day. And ICD-10 pairing should be R13.10 (dysphagia) or the appropriate pediatric feeding diagnosis. The other big denial trigger? Confusing 92610 (evaluation) with 92526 (treatment of swallowing). They look related. They aren't interchangeable.
Concrete: a hospital SLP credentialed in FEES runs a combined FEES + sensory study on an adult post-stroke patient. Bill 92616 once. Not 92612 + 92614. Not 92610 + 92616.
AAC Evaluation: 92607 and 92608
The AAC evaluation pair is the only place in the eval family where minute-level time tracking is required at the point of care.
92607 covers the first hour of face-to-face AAC evaluation. The hour is the time you're actually with the patient, not time spent on setup, scoring, or report writing afterward.7
92608 is each additional 30 minutes of face-to-face AAC evaluation, billed in multiple units if needed (one unit equals 30 minutes). It's an add-on code and never bills without 92607 on the same claim.8
When the evaluation spans multiple sessions (a four-week loaner-device trial is the classic case), the claim goes out on the last date of service.
The most common pitfalls? Guessing minutes instead of logging them at the point of care, submitting 92608 on a claim that doesn't include 92607, and using 92607 or 92608 for ongoing AAC therapy sessions. That work belongs to 92609 on the treatment side.
A concrete example. A pediatric SLP evaluates a 6-year-old with cerebral palsy. The first session runs 60 minutes. The second runs 45 minutes. The third runs 30 minutes. Total face-to-face: 135 minutes. The claim filed at the last session is 92607 once, plus 92608 twice (for the 60 additional minutes that meet the 30-minute increment). Five extra minutes? Doesn't round up. Time-stamps don't lie.
For the AAC code family including 92609 on the treatment side, see our CPT 92607, 92608, and 92609 AAC billing guide.
96105 (Aphasia Assessment) and 96125 (Cognitive Performance Testing)
These two codes don't get the same airtime as 92521 through 92524, but they're where adult-population SLPs do some of their most billable evaluation work, and they're billed differently from everything else in the family.
96105 is a standardized assessment of aphasia. The Boston Diagnostic Aphasia Examination is the most-cited example. It's billed per hour, common in adult neurogenic caseloads after stroke or TBI.
96125 is standardized cognitive performance testing, with the Ross Information Processing Assessment as the often-cited example. It's also billed per hour, used for cognitive-communication evaluation distinct from the cognitive-communication treatment codes (97129 and 97130).
The differentiator: both codes are time-based, and the hour includes time spent interpreting results and writing the report. That's where SLPs trained on the untimed 92521 through 92524 set most often leave money on the table. Per ASHA, 96125 requires at least 31 minutes of combined face-to-face plus scoring and report time to bill the first hour.9
These codes don't replace 92523. A comprehensive language evaluation that includes a standardized aphasia battery may require both, with documentation supporting each as a distinct service. The trick is logging your time at the point of charting, not from memory two days later.
Concrete: an adult-population SLP at a private practice evaluates aphasia post-stroke. Forty-five minutes face-to-face with the patient on the BDAE, plus another 30 minutes scoring and writing the report. That's one unit of 96105 (75 total minutes meets the first hour threshold with room to spare for the next 15 minutes of the next unit, depending on payer policy).
Same-Day Billing, Modifiers, and Documentation That Survives an Audit
Most evaluation denials aren't about picking the wrong code. They're about same-day rules, missing modifiers, and notes that don't support the code on the claim. Here's the short version of each.
Same-day pairings allowed (each separately documented as a complete evaluation):
- 92521 + 92523 (fluency + speech-language)
- 92521 + 92524 (fluency + voice)
- 92607 + 92608 (always paired)
Same-day pairings prohibited or restricted:
- 92522 + 92523 (CCI bundled, always)
- 92610 + 92611 same day (duplication)
- Any evaluation code + 92507 treatment same day. Medicare generally disallows this without Modifier 59 plus exceptional documentation supporting two genuinely distinct encounters.10
Modifiers SLPs need to know for evaluations:
- GN. Required on every Medicare Part B SLP claim, evaluations included. It tells the payer the service was delivered under a speech-language pathology plan of care. Miss it and the claim is denied automatically.10
- KX. Required once the patient's annual therapy charges cross the 2026 threshold ($2,480 for combined PT and SLP).2 KX signals continued medical necessity above the threshold.
- 52. Partial service. Use when an evaluation starts but isn't fully completed.
- 59. Distinct procedural service. Use with documented clinical justification, not as a default workaround. Overuse is itself an audit trigger.1
- 95. Telehealth modifier for synchronous audio-visual sessions.
Documentation that defends any evaluation code:
- Standardized assessments named and scored. "SSI-4, total score 22, severity moderate" is defensible. "Conducted fluency assessment" is not.
- Speech samples and clinical observations recorded, not summarized into adjectives.
- Functional impact on participation described concretely (school, work, communication partners).
- Explicit medical necessity for skilled SLP services. Not just what you did, but why this patient needed a licensed SLP.
- CPT and ICD-10 link visible in the note.
- Treatment plan tied directly to findings with measurable goals.
One rule worth writing on a sticky note: write the evaluation note so a reader who's never met the patient can identify which code you billed without you telling them. If the documentation requires the code to make sense, the code isn't supported.
Setting-Specific Notes: University Clinics, School-Based SLPs, Private Practice
The codes are the same across settings. The workflow around them isn't.
University clinics. Student clinician documentation must be reviewed and co-signed by the supervising SLP. Under Medicare Part B, students cannot bill independently.3 Real-time supervisor review and document completion verification are the workflow that prevents missed sign-offs and dropped claims. Universities also tend to run more 96105 and 96125 evaluations in adult clinic rotations, where the time-based billing rules need to be taught explicitly to graduate clinicians coming off pediatric placements.
School-based SLPs. Evaluation billing depends heavily on state Medicaid rules, and many states bill 92521 through 92524 differently than commercial payers. Some require additional codes or documentation linked to the IEP process. The evaluation narrative often does double duty, feeding both the billing claim and the IEP. Verify your state's rules before assuming what works in private practice transfers over.
Private practice. CFs (clinical fellows) follow CF supervision rules under Medicare; state Medicaid varies. Modifier accuracy matters more here than anywhere else because denial rework time has a direct dollar cost, and a missing GN on a 92523 claim costs the same fix time whether the practice is one therapist or ten.
Concrete: a CF in a private practice billing 92523 for a Medicare Part B patient needs the supervising SLP's sign-off in the chart, GN on the claim, KX if the patient is past the threshold, and the CPT and ICD-10 link spelled out in the evaluation note.
Pick the Code That Matches What You Actually Did
The big idea behind the whole evaluation code family is simple: bill the code that matches what you assessed and documented, not what the patient was referred for. Most denials in this space aren't coding failures. They're documentation failures. Tighten the note, and the code defends itself.
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Sources
- https://www.medbridge.com/blog/slp-cpt-codes-how-to-optimize-your-billing-for-success
- https://www.asha.org/practice/reimbursement/coding/newcodesslp/
- https://www.asha.org/practice/reimbursement/coding/new-cpt-evaluation-codes-for-slps/
- https://medibillmd.com/blog/cpt-code-92522/
- https://www.sprypt.com/cpt-codes/92614-92616
- https://www.sprypt.com/cpt-codes/92610
- https://www.sprypt.com/cpt-codes/92607
- https://www.sprypt.com/cpt-codes/92608
- https://www.asha.org/practice/reimbursement/coding/codingfaqsslp/
- https://www.asha.org/practice/reimbursement/medicare/slpcodingrules/