CPT 92523: Speech Sound Production Evaluation
Medicare pays $234 and commercial payers pay $327 on average nationally for this procedure.
CPT code 92523 describes a speech–language pathology evaluation of a patient’s speech sound production to assess articulation and phonological errors; this diagnostic clinical assessment is a speech–language pathology service typically performed in outpatient clinics, pediatric or adult speech therapy centers, or inpatient rehabilitation and acute care settings.
For related coverage guidance, see recent payer policy updates: Clinical Review Criteria Intraoperative Neurophysiological Monitoring (IONM), Remote Electrical Neuromodulation for Migraines (i.e., Nerivio®), Lumbar Microdiscectomy.
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National Reimbursement Benchmarks
Medicare’s mean rate for CPT 92523 sits at $234.50, closely aligned with BUCA’s commercial average of $326.80; the commercial average is about $92 higher than Medicare, indicating a modest uplift for commercial contracts relative to Medicare baseline rates. Medians diverge more among commercial payers, with Blue Cross Blue Shield and Cigna showing medians well above Medicare’s central locality value (Medicare p50 $230).
Dispersion measured as P75 minus P25 highlights variability: Cigna’s interquartile spread is $222.10 (P75 $447.20 − P25 $223.10), Blue Cross Blue Shield’s spread is $160.90, UnitedHealth Group’s spread is $189.50, Aetna’s spread is $122.10, and BUCA’s spread is $167.00. Cigna therefore exhibits the widest IQR, while Aetna is the tightest, signaling greater consistency in Aetna’s commercial rates and more variability in Cigna’s.