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    v1.0.28
    OpenPayerBilling CodesTemporary National Codes (Non-Medicare)HCPCS hcpcs-s9128-speech-therapy-home-per-diem
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    HCPCS S9128: Speech Therapy, In-Home, Per Diem

    Commercial payers pay $109 on average nationally for this procedure.

    HCPCS Level II code S9128 represents speech therapy provided in the home on a per diem basis, covering skilled evaluation and treatment sessions delivered at a patient’s residence; the service type is speech therapy and the typical site of service is home health / in-home care.

    For related coverage guidance, see recent payer policy updates: Fixed Wing Air Ambulance Transport, Air Ambulance, Ambulance Services (for New Mexico Only).

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    National Reimbursement Benchmarks

    National commercial pricing for HCPCS S9128 centers around BUCA’s average commercial rate of $109.10, which provides a mid-market anchor between payers with narrower versus wider spreads. Blue Cross Blue Shield (BCBS) and Cigna show higher central tendencies, with Cigna’s mean at $177.60 and BCBS’s mean at $117.10, while Aetna sits substantially lower around the high $30s. UnitedHealth Group’s mean of $79.80 falls between Aetna and BUCA. These differences highlight distinct contracting tiers across national payers.

    Dispersion measured as the interquartile gap (P75 minus P25) reveals tightest variability for Cigna and Aetna, both effectively showing a P75–P25 gap of $82.10 for Cigna (P75 $211.60 minus P25 $129.50) and $0.00 for Aetna (P75 $38.00 minus P25 $38.00) indicating a highly consistent Aetna band. UnitedHealth Group displays a wide IQR of $122.00 (P75 $122.00 minus P25 $0.00), and BCBS’s IQR is $34.80 (P75 $134.60 minus P25 $95.80), reflecting more spread in contracted rates across those networks.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a homebound adult recovering from stroke who requires ongoing speech therapy for language and swallowing impairments. A 72-year-old with left hemispheric ischemic stroke presents with expressive aphasia (R47.01) and mild oropharyngeal dysphagia (R13.10). The patient has difficulty forming words, reduced verbal expression, occasional choking on liquids, and needs functional communication strategies and swallowing safety training. A licensed Speech-Language Pathologist (taxonomy 235Z00000X) performs an initial home visit to evaluate communication and swallow function, establishes a per diem plan of care, provides direct therapeutic interventions (articulation drills, language stimulation, compensatory swallow maneuvers), trains family caregivers, documents progress, and communicates with the primary care physician and home health agency (taxonomy 251E00000X).

    The clinical workflow includes: pre-visit review of medical records and medication list; in-home assessment with standardized screens and functional swallow trials; targeted therapy and caregiver education; daily documentation of interventions and patient response tied to the per diem billing unit S9128; periodic re-evaluation using S9152 or time-based encounter codes such as G0153 if sessions are billed by 15-minute increments; coordination with rehabilitation practitioner (taxonomy 225X00000X) and referring providers; and periodic care plan updates, including consideration of modifier use for unusual circumstances (for example, modifier 22 for increased procedural services or 59 for distinct procedural services when applicable).

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    235Z00000XSpeech-Language PathologistThe speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in…
    225X00000XOccupational TherapistAn occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for O…
    251E00000XHome Health AgencyA public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing se…
    101YP2500XProfessional CounselorBehavioral Health & Social Service Providers · Counselor
    341600000XAmbulanceAn emergency vehicle used for transporting patients to a health care facility after injury or illness. Types of ambulances used in the United States i…
    246QH0000XHematology Specialist/TechnologistTechnologists, Technicians & Other Technical Service Providers · Specialist/Technologist, Pathology
    173000000XLegal MedicineThe specialty areas of medicine concerned with matters of, and relations with, substantive law and legal institutions; such as the conduct of medical …
    261QR0400XRehabilitation Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center

    Related Payer Policy Updates

    Specialty: Emergency & Medical Transportation1 / 3

    10 rows

    PolicyPayerEffective Date
    Fixed Wing Air Ambulance TransportCigna2026-08-15
    Air AmbulanceAmbetter Georgia2026-08-01
    Ambulance Services (for New Mexico Only)UnitedHealthcare2026-08-01
    Ambulance Services (for Tennessee Only)UnitedHealthcare2026-08-01
    Clinical Policy: Air AmbulanceArizona Complete Health2026-08-01
    Air AmbulanceCentene2026-08-01
    Clinical Policy: Air AmbulanceCentene2026-08-01
    Clinical Policy: Air AmbulanceAmbetter Nevada2026-08-01
    Ambulance TransportProvidence Health Plan2026-07-01
    Air ambulance transport coverage criteriaeocco2026-07-01

    Related Codes

    HCPCS-LEVEL-II-S2152-SOLID-ORGAN-TRANSPLANTATION-GLOBAL-CARE

    HCPCS Level II S2152: Solid Organ Procurement and Transplantation

    HCPCS-LEVEL-II-S2266-INDUCED-ABORTION-29-TO-31-WEEKS

    HCPCS Level II S2266: Induced Abortion, 29 to 31 Weeks

    HCPCS-LEVEL-II-S3630-EOSINOPHIL-COUNT-BLOOD-DIRECT

    HCPCS Level II S3630: Eosinophil Count, Blood, Direct

    HCPCS-LEVEL-II-S4017-INCOMPLETE-ART-CYCLE-CANCELLED-PRIOR-TO-STIMULATION

    HCPCS Level II S4017: Incomplete Cycle — Cancelled Prior to Stimulation

    HCPCS-LEVEL-II-S8055-ULTRASOUND-GUIDANCE-MULTIFETAL-REDUCTION-TC

    HCPCS Level II S8055: Ultrasound Guidance for Multifetal Pregnancy Reduction

    HCPCS-LEVEL-II-S8940-EQUESTRIAN-HIPPOTHERAPY-PER-SESSION

    HCPCS Level II S8940: Equestrian/Hippotherapy, Per Session

    HCPCS-LEVEL-II-S9024-PARANASAL-SINUS-ULTRASOUND

    HCPCS Level II S9024: Paranasal Sinus Ultrasound

    HCPCS-LEVEL-II-S9366-HOME-TPN-1-2L-PER-DAY-HOME-INFUSION

    HCPCS Level II S9366: Home Infusion TPN, 1–2 L/day

    HCPCS-LEVEL-II-S9446-GROUP-PATIENT-EDUCATION-NON-PHYSICIAN

    HCPCS S9446: Patient Education, Non-Physician Provider, Group, Per Session

    HCPCS-LEVEL-II-S9451-EXERCISE-CLASS-NON-PHYSICIAN-SESSION

    HCPCS S9451: Exercise Classes, Non-Physician Provider, Per Session

    Showing 1–10 of 532

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    Frequently Asked Questions

    References

    1. 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. 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. 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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    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    G0153Services of a speech and language pathologist in home health or hospice settings, each 15 minutesAlternative time-based billing method for home speech therapy; used when services are documented in 15-minute units rather than per diem S9128.
    S9152Speech therapy, re‑evaluationUsed for formal re-evaluation visits to assess progress and update the treatment plan; may be billed in addition to or instead of the per diem when re-evaluation criteria are met.