CY2026 MPFS · Audiology + SLP

Two provider types, one rulebook, and a stack of billing layers

Here is the short answer. Under 2026 direct access, an audiologist can bill a defined set of 92xxx diagnostic tests without a physician order, once per 12-month period, for non-acute hearing and balance complaints. Everything else, treatment, acute-onset workups, and the DME side of speech-generating devices, still routes through an order. SLP telehealth stays payable, but only while the current extensions hold and only with the right place-of-service and modifiers. This page separates each layer so your front end stops guessing.

ABHCPCS modifier that flags an audiology service furnished under direct access, no order attached

1 / 12moDirect-access diagnostic frequency limit per beneficiary before an order is required again

92xxxThe audiology and SLP CPT family that carries almost every code on this page

E2500+HCPCS range for speech-generating devices, billed as DME under NCD 50.1, not as a 92xxx service

Layer 1 · Audiology

What direct access covers, and what still needs an order

The CY2023 Physician Fee Schedule created direct access and the AB modifier. The CY2026 rule keeps that structure in place. The dividing line is not the code family, it is the intent. Diagnostic, non-acute, once a year sits on the left. Treatment and acute-onset work sits on the right.

✓

Bills under direct access

AB modifier · once per 12 months

92557

Comprehensive audiometry

Threshold and speech recognition for a routine, non-acute hearing complaint.

92567 · 92568

Tympanometry + acoustic reflex

Middle-ear function on the direct-access diagnostic list.

92587 · 92588

Otoacoustic emissions

Limited or comprehensive OAE, diagnostic and order-free within the annual limit.

92620 · 92621

Central auditory function eval

Diagnostic assessment furnished without a referral under direct access.

92625

Tinnitus assessment

Diagnostic evaluation of tinnitus, non-acute, appended with AB.

Still requires a physician order

referral on file before you bill

Acute onset

Sudden hearing loss or vertigo

Symptoms needing medical management fall outside direct access, order first.

2nd visit

Same-year repeat testing

Anything past the once-per-12-months direct-access limit needs an order.

92540 · 92548

Vestibular / balance work-ups tied to a condition

Balance testing driven by a diagnosed disorder is treatment-adjacent, not routine direct access.

Treatment

Aural rehab and therapeutic services

Direct access is diagnostic only. Therapy-side services still route through referral.

Device order

SGD / hearing device fitting path

The DME order and coverage rules apply, not the AB direct-access pathway.

Layer 2 · SLP telehealth

Speech-language pathology across the wire in 2026

SLPs are recognized Medicare telehealth distant-site practitioners while the current statutory extensions remain in force. Payment survives, but the claim only clears with the right place-of-service, the audio-video reality of the visit, and therapy-threshold discipline. Codes below are the common SLP set.

CPT	Service	Telehealth 2026	Watch for
92507	Speech / language treatment, individual	On list	KX modifier once the annual therapy threshold is crossed
92508	Speech / language treatment, group	Conditional	Group telehealth parity varies, confirm on the current Telehealth Services List
92521-92524	Fluency, voice, and sound production evals	On list	Documentation of standardized measures collected remotely
92526	Treatment of swallowing / feeding	Conditional	Dysphagia hands-on components may force an in-person visit
96125	Standardized cognitive performance testing	On list	Per-hour timed code, document face-to-face minutes

Layer 3 · AAC devices

The AAC / speech-generating device path is two claims, not one

This is where operators lose money. The evaluation is a 92xxx service. The device itself is DME under National Coverage Determination 50.1, billed on the HCPCS E25xx range with the physician order and coverage documentation. Run them as separate layers.

SLP evaluation

92607 · 92608

Evaluation for prescription of a speech-generating device. First hour plus each additional 30 minutes.

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Physician order

NCD 50.1

Order and medical necessity documentation tie the device to the evaluation. This is the gate the DME claim needs.

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Device (DME)

E2500-E2599

The speech-generating device and mounting / accessories bill through the DME MAC, not on the therapy claim.

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Therapy with device

92609

Ongoing therapeutic service for use of the SGD, billed as a 92xxx service once the device is in place.

Sources

The 2026 guidelines behind every layer

CY2026 Medicare Physician Fee Schedule final ruleCarries forward audiology direct access and the AB modifier framework, updates payment for 92xxx services.

CY2023 PFS (CMS-1770-F)Established audiology direct access, the once-per-12-months limit, and the AB modifier.

Medicare Telehealth Services ListDefines which SLP 92xxx codes are payable via telehealth and under what conditions each year.

Consolidated Appropriations Act telehealth extensionsThe statutory basis keeping SLPs as eligible distant-site telehealth practitioners.

NCD 50.1, Speech Generating DevicesNational coverage rules that push the AAC device onto a DME claim with a physician order.

CPT 2026 code set (AMA) + ASHA coding guidanceDescriptors for the 92xxx audiology and SLP families and AAC / SGD evaluation codes.

Stop leaving the AB modifier and the SGD split to chance

Most audiology and SLP denials we see are not clinical, they are layer errors, a missing order where direct access did not apply, a device billed on the therapy claim, a telehealth POS that no longer matched the code. ASP-RCM builds the edits that catch each layer before the claim goes out, and works the ones that already fell through. We do this for audiology, SLP, and multi-specialty groups every day.

Map your speech-audiology billing layers →