Summary & Overview
CPT 92507: Individual Treatment of Speech, Language, Voice, and Communication Disorders
CPT code 92507 represents individual treatment for speech, language, voice, communication, and auditory processing disorders. This code is widely used by speech-language pathologists to deliver targeted therapy aimed at improving communication abilities in patients with a variety of disorders, including phonological, expressive language, and aphasia. The service is most commonly provided in an office setting, reflecting its role in outpatient care.
Major national payers covering this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage policies and reimbursement benchmarks for 92507 are essential for providers and stakeholders to understand, as they impact access to speech-language pathology services across the country.
This publication offers a comprehensive overview of 92507, including payer coverage, clinical context, and related billing codes. Readers will gain insight into current policy updates, typical diagnoses associated with the code, and how it fits within the broader landscape of speech-language pathology services. The analysis also highlights relevant modifiers and taxonomies, providing a clear picture of how this code is utilized in clinical practice.
CPT Code Overview
CPT code 92507 is used to report the treatment of speech, language, voice, communication, and/or auditory processing disorders provided to an individual. This service falls under the Speech-Language Pathology category and is typically performed in an office setting (Place of Service 11). The procedure is designed to address a range of communication challenges, supporting patients in improving their speech and language abilities through individualized therapy sessions.
Clinical & Coding Specifications
Clinical Context
A patient, such as a child or adult, presents to a speech-language pathologist in an office setting (Place of Service 11) with difficulties in speech, language, voice, communication, or auditory processing. The patient may have a diagnosis such as phonological disorder, expressive language disorder, mixed receptive-expressive language disorder, aphasia, or apraxia. After an initial evaluation, the provider develops an individualized treatment plan. The patient attends regular, one-on-one therapy sessions focused on improving specific communication abilities, which are documented and billed using CPT code 92507.
Coding Specifications
| Modifier Code | Description |
|---|---|
GN | Services delivered under an outpatient speech-language pathology plan of care |
GO | Services delivered under an outpatient occupational therapy plan of care |
- Modifier
GNis used when the service is part of a speech-language pathology plan of care, typically required by payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare for outpatient therapy claims. - Modifier
GOis used when the service is part of an occupational therapy plan of care.
Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
235Z00000X | Speech-Language Pathologist |
2355S0801X | Speech-Language Pathologist, School |
2355A2700X | Speech-Language Pathologist, Assistive Technology Practitioner |
- These taxonomies represent providers qualified to deliver speech-language pathology services in various settings, including schools and assistive technology environments.
Related Diagnoses
-
F80.0— Phonological disorder: Relevant for patients with difficulty in speech sound production, often addressed in individual therapy sessions billed with92507. -
F80.1— Expressive language disorder: Applies to patients who struggle to express themselves verbally, a primary focus of speech-language pathology treatment. -
F80.2— Mixed receptive-expressive language disorder: Indicates patients with both understanding and expressive language difficulties, commonly treated with92507. -
R47.01— Aphasia: Pertains to patients with impaired language ability due to neurological conditions, requiring individualized therapy. -
R48.2— Apraxia: Refers to patients with motor planning deficits affecting speech, often necessitating targeted speech-language therapy.
Related CPT Codes
| CPT Code | Description | Clinical Relationship |
|---|---|---|
92506 | Evaluation of speech, language, voice, communication, and/or auditory processing | Used for initial assessment before treatment with 92507 |
92508 | Group treatment of speech, language, voice, communication, and/or auditory processing disorder | Alternative to 92507 for group therapy sessions |
92521 | Evaluation of speech fluency (e.g., stuttering, cluttering) | May be used for specific fluency evaluation prior to treatment |
92522 | Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) | Used for targeted evaluation of speech sound disorders before therapy |
92506,92521, and92522are commonly used for evaluation prior to initiating individual treatment with92507.92508is used when therapy is provided in a group setting rather than individually.
National Reimbursement Benchmarks
Medicare's national mean rate for CPT code 92507 is $78.79, which is lower than the BUCA (Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna) average commercial mean rate of $95.93. Among the commercial payers, UnitedHealth Group and Cigna have the highest mean rates, at $123.21 and $121.36 respectively, while Aetna and Blue Cross Blue Shield are closer to Medicare.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare shows the tightest range ($5.00), indicating minimal variation in rates. In contrast, Cigna and UnitedHealth Group have the widest dispersions ($72.00 and $75.50 respectively), reflecting greater variability in commercial reimbursement. The table and chart below present the full breakdown of national benchmarks for CPT code 92507.
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