Speech & Audiology Billing · 2026

One clinic, two rulebooks. Bill each line the way CMS wrote it.

Here is the short answer. In 2026 your speech-language pathology charges share a single dollar threshold with physical therapy and ride the KX modifier once you cross it. Your audiology charges do not touch that threshold at all. They run on direct access and the AB modifier. Same front desk, same superbill, two completely different compliance clocks.

SLP line
Combined PT + SLP KX threshold, then attest with the KX modifier.
Audiology line
No therapy threshold. Direct access billed with the AB modifier.
The numbers that decide the claim

Four figures every combined clinic should have taped to the wall

No invented statistics here. These are the mechanics CMS publishes, anchored to the last confirmed dollar amount so your team knows exactly how the 2026 figure is built.

1
Shared threshold covering both PT and SLP allowed charges combined. Occupational therapy carries its own separate threshold.
Combined PT / SLP cap
$2,410
The confirmed CY2025 combined KX threshold. CMS re-indexes this each year by the Medicare Economic Index in the CY2026 PFS final rule.
2025 anchor, MEI-indexed for 2026
$3,000
Targeted medical review threshold, frozen at this amount through CY2027 by the Bipartisan Budget Act of 2018.
Fixed through 2027
12 mo
Direct-access audiology diagnostics are billable with the AB modifier once per beneficiary per 12 months, from a defined CPT list.
AB modifier rule
Side by side

The speech vs audiology billing matrix for 2026

Read every row across. The left column is what changes, the blue column is your SLP line, the gold column is your audiology line. The gap between them is where combined clinics leak revenue.

DimensionWhat you compare
SLPSpeech-Language PathologyA therapy service. Shares the PT threshold.
AUDAudiologyA diagnostic service. Direct access.
Threshold it uses
Combined PT + SLP KX threshold. Every SLP allowed charge counts against the same running total as physical therapy.
None. Audiology diagnostics are not therapy services and never accrue toward the KX threshold.
The modifier
✓ KX
Append KX once combined PT + SLP crosses the threshold, attesting the service stays medically necessary.
✓ AB
Append AB when the audiologist personally furnishes a listed diagnostic test under direct access, with no physician order.
Physician order
✕ Still required
SLP has no Medicare direct access. Services need a certified plan of care under a physician or NPP.
✓ Not required
The beneficiary may go straight to the audiologist for non-acute hearing and balance assessment.
Plan of care
Yes. Certified plan of care and progress reporting under the outpatient therapy benefit.
No. Diagnostic evaluation, not a therapy plan. Findings return to the ordering source when there is one.
Frequency limit
Driven by medical necessity across the episode. Watch the running combined total.
Once per 12 months per beneficiary for the direct-access code list. A second visit needs the standard order path.
What triggers review
Crossing the $3,000 targeted medical review threshold (PT + SLP combined) can flag the claim for documentation review.
Missing or wrong AB use, or a second direct-access test inside 12 months, is the usual denial cause.
Governing rule
CY2026 Medicare Physician Fee Schedule final rule, outpatient therapy KX policy, plus ASHA threshold guidance.
Audiology direct access and the AB modifier, established in the CY2023 PFS final rule and in force for 2026, plus ASHA guidance.
Decision flow

How a single encounter splits into two clean claims

One patient can see the SLP and the audiologist in the same building on the same day. The claim logic forks the moment you name the service line.

Combined clinic one encounter SLP therapy line plan of care + physician cert Track combined PT + SLP total. Cross threshold → add KX Audiology line direct access, no order Confirm listed CPT + 12-month rule. Personally furnished → add AB
The SLP clock

What happens as your PT and SLP total climbs

Follow one shared-threshold episode from the first visit to the review flag. The audiology line never appears on this timeline, and that is the whole point.

$0

Episode opens

PT and SLP allowed charges start accruing to the same combined running total. No modifier needed yet.

KX

Combined total crosses the annual threshold

Every further PT and SLP line carries KX, attesting continued medical necessity. Skip it and the line denies as over-threshold.

MR

Combined total reaches $3,000

The claim can be selected for targeted medical review. This $3,000 figure is statutory and holds through CY2027. Your documentation, not the modifier, is what carries it.

OT

Occupational therapy stays separate

A common miss. OT rides its own threshold, so do not fold OT dollars into the PT + SLP total.

Cite the source, win the appeal

The real 2026 guidelines behind every rule on this page

CMS

CY2026 Medicare Physician Fee Schedule final rule

Sets the annually indexed KX modifier threshold that PT and SLP share, updated by the Medicare Economic Index.

CMS · Outpatient therapy

KX modifier threshold policy

The combined PT/SLP threshold and the KX medical-necessity attestation, with OT on a distinct threshold.

Statute · BBA 2018

$3,000 targeted medical review threshold

Fixed at $3,000 for combined PT + SLP through CY2027 under the Bipartisan Budget Act of 2018.

CMS

Audiology direct access & AB modifier (CY2023 PFS)

Established beneficiary direct access to audiologists for non-acute assessment, billed with the AB modifier, in force for 2026.

ASHA

ASHA threshold & direct-access guidance

Practice guidance interpreting the shared SLP threshold, KX use, and the audiology AB modifier code list and 12-month limit.

CMS · NCCI

Coding edits on combined claims

Test SLP and audiology lines on complete claims, not line extracts, so shared-day edits surface before submission.

Where combined clinics lose money

Five denial traps that live in the gap between the two rules

01

Counting audiology toward the threshold. Diagnostic audiology never accrues to the KX total. Doing so can push SLP to premature KX or a false review flag.

02

Forgetting KX after crossing. Once combined PT + SLP passes the threshold, every SLP line needs KX or it denies as over-cap.

03

AB on a non-listed code. The AB modifier belongs only on the defined direct-access CPT list. Using it elsewhere invites recoupment.

04

Second direct-access test inside 12 months. A repeat within the window needs the standard order path, not AB.

05

Folding OT into the PT + SLP total. OT rides its own threshold. Mixing them distorts both running totals.

06

Treating SLP like audiology. SLP has no direct access. Missing the physician-certified plan of care voids the whole episode.

Your front desk shares a superbill. Your billing logic should not.

ASP-RCM Solutions builds the split into your workflow so SLP lines track the shared PT threshold and drop KX on time, while audiology lines run direct access with the AB modifier and the 12-month check, every claim, without a coder holding two rulebooks in their head. Fewer over-threshold denials, cleaner medical-review defense, faster cash on both service lines.

Talk to our speech & audiology billing team →
Guideline references current to the CY2026 Medicare PFS. Verify current-year figures against the final rule before filing.

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