CPT 96105: Aphasia Evaluation by Speech-Language Pathologist
Medicare pays $100 and commercial payers pay $133 on average nationally for this procedure.
CPT code 96105 is an evaluation administered by a physician or licensed speech-language pathologist to assess aphasia — a communication disorder often caused by stroke or brain injury — and measures a patient’s ability to understand and use language; service type: aphasia/communication assessment, typical site of service: outpatient clinic or inpatient hospital setting.
For related coverage guidance, see recent payer policy updates: Esophagogastroduodenoscopy (EGD) Coverage Policy, Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD), Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing.
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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.