CPT 92526: Evaluation and Treatment of Swallowing Disorder
Medicare pays $87 and commercial payers pay $144 on average nationally for this procedure.
CPT code 92526 describes evaluation and treatment of a swallowing disorder (dysphagia) including therapeutic interventions such as medication management, swallowing rehabilitation, or feeding-tube management; this service is typically delivered as speech-language pathology rehabilitation and is commonly provided in inpatient, outpatient, or skilled nursing facility settings depending on clinical need.
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
Commercial averages sit well above Medicare for CPT 92526: Blue Cross Blue Shield and BUCA show notably higher mean reimbursements, with BUCA’s mean at $144.30 versus Medicare’s mean of $87.20. Blue Cross Blue Shield’s mean ($166.70) and Cigna ($129.50) also exceed Medicare by substantial margins, while Aetna ($86.80) and UnitedHealth Group ($127.00) spread around Medicare’s level, reflecting that commercial contracts generally reimburse more than Medicare for this service.
Dispersion measured as the difference between the 75th and 25th percentiles highlights which payers are most and least variable: Blue Cross Blue Shield is the widest with a P75–P25 spread of $104.80 ($211.20–$106.40), followed by UnitedHealth Group at $77.60 ($160.80–$82.40). Aetna is relatively tight at $37.20 ($107.10–$39.90), and BUCA’s interquartile spread is $92.00 ($181.90–$90.60). Cigna’s spread is $73.40 ($160.10–$86.70). Medicare’s interquartile range is narrow at $7.00 ($89.00–$82.00).