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CPT 96105: Evaluation for Aphasia and Communication Ability

CPT code 96105 represents a clinician-conducted evaluation specifically for aphasia, a communication disorder commonly caused by stroke or traumatic brain injury. As a targeted diagnostic assessment, the code captures structured testing of a patient’s receptive and expressive language abilities to guide diagnosis, therapy planning, and coordination with neurology or speech-language pathology services. Nationally, accurate coding for aphasia evaluations supports appropriate clinical pathways for post-stroke and neuro-oncology populations and informs resource allocation for speech and language services.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for 96105, how it relates to cognitive and speech assessments, and its positioning relative to related codes such as 96125. The publication summarizes typical sites of service and service type, common billing modifiers and provider taxonomies associated with this evaluation, and relevant ICD-10 diagnosis groupings commonly linked to aphasia evaluations. This material is intended for billing professionals, clinical program managers, and policy analysts seeking a concise reference to the clinical meaning, payer relevance, and coding relationships for CPT code 96105.

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Billing Code Overview

CPT code 96105 describes an evaluation for aphasia, a language disorder that impairs a patient’s ability to understand or use words, most commonly resulting from stroke or brain injury. The service documents a provider-led assessment of a patient’s communication abilities to identify the presence and severity of aphasia and to inform care planning.

Service type: Diagnostic communication/aphasia evaluation performed by a qualified clinician
Typical site of service: Outpatient clinic or hospital outpatient setting; may also occur in inpatient rehabilitation or acute care when clinically indicated

National Reimbursement Benchmarks

Medicare’s national mean of $100.2 sits well below BUCA’s average commercial mean of $133.4, indicating commercial contracts in the BUCA aggregate pay about $33.2 more on average for CPT 96105 than Medicare. That gap highlights a meaningful commercial–public divergence in valuation for this service. Dispersion varies materially by payer: compute P75−P25 ranges to compare concentration. Blue Cross Blue Shield shows a wide interquartile spread of $53.4 (P75 $156.5 − P25 $103.1), and UnitedHealth Group is also broad at $104.3 (P75 $204.7 − P25 $100.4). By contrast, Aetna’s IQR is $29.0 (P75 $106.0 − P25 $74.0) and Cigna’s is $89.0 (P75 $181.6 − P25 $96.0), so Aetna appears the tightest while UnitedHealth Group is the widest in IQR terms.

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CPT 96105: Evaluation for Aphasia and Communication Ability

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Billing Code Overview

Service type: Diagnostic communication/aphasia evaluation performed by a qualified clinician
Typical site of service: Outpatient clinic or hospital outpatient setting; may also occur in inpatient rehabilitation or acute care when clinically indicated

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 68-year-old right-handed patient presents to an outpatient neurology clinic three weeks after an ischemic stroke involving the dominant hemisphere with persistent word-finding difficulty, impaired comprehension of complex sentences, and reduced verbal expression. The patient is referred by the treating neurologist for a formal speech-language evaluation to characterize the type and severity of aphasia, document baseline communication function, and guide rehabilitation planning. The evaluation is performed by a licensed speech-language pathologist in an outpatient rehabilitation clinic or hospital-based speech pathology suite and includes standardized aphasia testing, conversational speech sampling, reading and writing tasks, and caregiver interview. Results are documented in the medical record and communicated to the referring neurologist and rehabilitation team to inform therapy frequency and goals. Typical sites of service include outpatient rehabilitation clinics, hospital outpatient departments, inpatient rehabilitation units, and skilled nursing facilities when speech-language pathology services are provided at the bedside.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional interpretation or assessment component separated from technical components when applicable.
`59`	Distinct procedural service	Use when this evaluation is a distinct and separate service from other procedures on the same day (for example, a separate neuropsychological test).
`52`	Reduced services	Use when the full evaluation is not completed and services are partially reduced.
`53`	Discontinued procedure	Use when the evaluation is started but discontinued due to patient instability or other valid reasons.
`57`	Data not available in the input.	Data not available in the input.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Use when the aphasia evaluation is delivered via live interactive telehealth technology.
`QK`	Medical direction of two, three, or four trainees performing services	Use when a teaching physician medically directs trainees performing parts of the evaluation in a training setting.
`GC`	Service performed in part by a resident under teaching physician supervision	Use when portions are performed by a resident and attested under the teaching physician’s supervision.
`GN`	Speech-language pathology services provided under Medicare Part B (outpatient)	Use to indicate speech-language pathology professional services when required by payer reporting.
`GP`	Services rendered under an outpatient physical therapy plan of care	Use if reporting the service under therapy-related billing where applicable.
`KX`	Requirements specified in the medical policy have been met	Use when payer-specific documentation or medical necessity criteria are met for coverage.
`XE`	Separate encounter, a patient encounter on a different date or time	Use when the evaluation represents a separate encounter distinct from other services.
`XP`	Separate practitioner	Use when a different practitioner performs this service distinct from other practitioners billing the same day.
`XU`	Unusual non-overlapping service	Use when documentation supports that the service is distinct and not overlapping with other reported services.

Taxonomy Code	Specialty	Notes
`225X00000X`	Speech-Language Pathologist	Primary clinician performing aphasia evaluation and documenting communication assessment.
`2084N0400X`	Neurology Physician	Referring or collaborating physician for neurological diagnosis and integration of assessment findings.
`103G00000X`	Clinical Neuropsychologist	May perform complementary cognitive assessments and collaborate on differential diagnosis and functional communication planning.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`A52.17`	General paresis	Neurosyphilis-related cortical dysfunction can cause language disturbances; included as a possible neurologic cause of aphasia that may prompt comprehensive language assessment.
`C71.0`	Malignant neoplasm of cerebrum, except lobes and ventricles	Cerebral tumors can disrupt language networks leading to aphasia; evaluation documents baseline communication for treatment planning.
`C71.1`	Malignant neoplasm of frontal lobe	Frontal lobe neoplasms may affect expressive language and speech initiation; aphasia assessment helps characterize deficits.
`C71.2`	Malignant neoplasm of temporal lobe	Temporal lobe lesions commonly impair comprehension and naming; aphasia testing evaluates these domains.
`C71.3`	Malignant neoplasm of parietal lobe	Parietal lobe involvement can affect language processing and praxis; assessment identifies specific deficits.
`C71.4`	Malignant neoplasm of occipital lobe	Occipital lesions may secondarily affect written language or visual naming; included for completeness when language changes are observed.
`C71.5`	Malignant neoplasm of cerebral ventricle	Tumors in ventricular regions may cause diffuse cortical dysfunction impacting language; evaluation documents impact.
`C71.6`	Malignant neoplasm of cerebellum	Cerebellar lesions can cause dysarthria and cognitive-communication deficits; aphasia testing differentiates language from motor-speech disorders.
`C71.7`	Malignant neoplasm of brain stem	Brainstem lesions more commonly affect motor speech and cranial nerves; assessment clarifies whether aphasia is present.
`C71.8`	Malignant neoplasm of overlapping sites of brain	Multifocal or overlapping brain tumors can produce mixed language deficits; formal aphasia evaluation characterizes global impact.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96125`	Assessment of cognitive performance testing (e.g., 1 or more procedures)	Often performed alongside aphasia testing to evaluate broader cognitive deficits that impact communication, informs differential diagnosis and rehabilitation planning.

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional interpretation or assessment component separated from technical components when applicable.
`59`	Distinct procedural service	Use when this evaluation is a distinct and separate service from other procedures on the same day (for example, a separate neuropsychological test).
`52`	Reduced services	Use when the full evaluation is not completed and services are partially reduced.
`53`	Discontinued procedure	Use when the evaluation is started but discontinued due to patient instability or other valid reasons.
`57`	Data not available in the input.	Data not available in the input.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Use when the aphasia evaluation is delivered via live interactive telehealth technology.
`QK`	Medical direction of two, three, or four trainees performing services	Use when a teaching physician medically directs trainees performing parts of the evaluation in a training setting.
`GC`	Service performed in part by a resident under teaching physician supervision	Use when portions are performed by a resident and attested under the teaching physician’s supervision.
`GN`	Speech-language pathology services provided under Medicare Part B (outpatient)	Use to indicate speech-language pathology professional services when required by payer reporting.
`GP`	Services rendered under an outpatient physical therapy plan of care	Use if reporting the service under therapy-related billing where applicable.
`KX`	Requirements specified in the medical policy have been met	Use when payer-specific documentation or medical necessity criteria are met for coverage.
`XE`	Separate encounter, a patient encounter on a different date or time	Use when the evaluation represents a separate encounter distinct from other services.
`XP`	Separate practitioner	Use when a different practitioner performs this service distinct from other practitioners billing the same day.
`XU`	Unusual non-overlapping service	Use when documentation supports that the service is distinct and not overlapping with other reported services.

Taxonomy Code	Specialty	Notes
`225X00000X`	Speech-Language Pathologist	Primary clinician performing aphasia evaluation and documenting communication assessment.
`2084N0400X`	Neurology Physician	Referring or collaborating physician for neurological diagnosis and integration of assessment findings.
`103G00000X`	Clinical Neuropsychologist	May perform complementary cognitive assessments and collaborate on differential diagnosis and functional communication planning.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`A52.17`	General paresis	Neurosyphilis-related cortical dysfunction can cause language disturbances; included as a possible neurologic cause of aphasia that may prompt comprehensive language assessment.
`C71.0`	Malignant neoplasm of cerebrum, except lobes and ventricles	Cerebral tumors can disrupt language networks leading to aphasia; evaluation documents baseline communication for treatment planning.
`C71.1`	Malignant neoplasm of frontal lobe	Frontal lobe neoplasms may affect expressive language and speech initiation; aphasia assessment helps characterize deficits.
`C71.2`	Malignant neoplasm of temporal lobe	Temporal lobe lesions commonly impair comprehension and naming; aphasia testing evaluates these domains.
`C71.3`	Malignant neoplasm of parietal lobe	Parietal lobe involvement can affect language processing and praxis; assessment identifies specific deficits.
`C71.4`	Malignant neoplasm of occipital lobe	Occipital lesions may secondarily affect written language or visual naming; included for completeness when language changes are observed.
`C71.5`	Malignant neoplasm of cerebral ventricle	Tumors in ventricular regions may cause diffuse cortical dysfunction impacting language; evaluation documents impact.
`C71.6`	Malignant neoplasm of cerebellum	Cerebellar lesions can cause dysarthria and cognitive-communication deficits; aphasia testing differentiates language from motor-speech disorders.
`C71.7`	Malignant neoplasm of brain stem	Brainstem lesions more commonly affect motor speech and cranial nerves; assessment clarifies whether aphasia is present.
`C71.8`	Malignant neoplasm of overlapping sites of brain	Multifocal or overlapping brain tumors can produce mixed language deficits; formal aphasia evaluation characterizes global impact.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96125`	Assessment of cognitive performance testing (e.g., 1 or more procedures)	Often performed alongside aphasia testing to evaluate broader cognitive deficits that impact communication, informs differential diagnosis and rehabilitation planning.

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.