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CPT 92526: Dysphagia Evaluation and Treatment Services
CPT code 92526 covers clinical evaluation and treatment of swallowing disorders (dysphagia), including medical management, rehabilitative therapy, and interventions involving feeding tubes to determine and address causes of impaired swallowing. Nationally, dysphagia services intersect acute, post-acute, and outpatient care settings and are critical for reducing aspiration risk, improving nutrition and hydration, and supporting safe oral intake for diverse patient populations.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. The publication outlines payer coverage considerations, common clinical indications, associated ICD-10 diagnoses such as R13.10–R13.14, and related functional and neuromuscular testing codes used in dysphagia workups.
Readers will find a concise overview of the clinical role of 92526, the typical sites of service where it is used, and the coding context that informs billing and documentation. The report highlights benchmarking and policy-relevant points for national stakeholders, including payers and provider organizations, and provides clinical context to help interpret how 92526 fits within multidisciplinary dysphagia care pathways. Data not available in the input are noted where applicable.
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Billing Code Overview
CPT code 92526 describes evaluation and treatment services for a swallowing disorder (dysphagia). The service encompasses medical management, therapeutic rehabilitation, and enteral feeding interventions when needed to identify and address causes of impaired swallowing function.
Service type: Dysphagia evaluation and treatment, including therapy and feeding-tube management
Typical site of service: Hospital inpatient, inpatient rehabilitation, skilled nursing facility, or outpatient clinic where speech-language pathology and interdisciplinary dysphagia care are delivered
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).