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Speech & Audiology Billing & RCM

Speech & Audiology billing and revenue cycle, 50-state coverage.

Speech-language pathology and audiology billing services from ASP-RCM Solutions. 31,841 NPPES speech / audiology billing providers across all 50 states + DC. HIPAA + SOC 2 Type II compliant. Senior partners on every account.

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What good speech / audiology billing execution looks like.

The operating discipline we install on every speech / audiology billing engagement.

  1. 8-minute rule + timed SLP code billingSLP treatment billing follows Medicare 8-minute rule for timed codes. Accurate time tracking is foundational.
  2. GN modifier discipline for SLPAll SLP services bill with GN modifier identifying speech-language pathology discipline.
  3. Plan of Care + recertification cycleMedicare requires physician-signed Plan of Care every 90 days for SLP. Recertification timing must be tracked.
  4. KX modifier above therapy thresholdSLP shares the therapy threshold with PT ($2,480 in 2026 combined). KX modifier and supporting documentation required above threshold.
  5. Audiology evaluation + hearing aid billingAudiology evaluations (92550-92588) and hearing aid fitting / dispensing (V5010-V5299, plus state-specific) require distinct workflow.
  6. Pediatric SLP + EPSDT / school-basedPediatric SLP may bill state Medicaid EPSDT, school-based services, ABA-adjacent communication services, or commercial. Each requires distinct workflow.

Threshold and evaluation map

Three rulebooks in one clinic, and only one of them is therapy.

A practice that delivers speech-language pathology and audiology under the same roof is running three different rulebooks at once. The therapy threshold decides how long the SLP side can go before an attestation is required. The timed versus untimed split decides whether session length changes the claim at all. Audiology sits outside both of them, on its own diagnostic path, with a statutory wall at the end of it. The exhibit below is drawn from the federal rules that govern each band, not from sample data and not from a client.

Speech and audiology threshold and evaluation map SPEECH, AUDIOLOGY AND THE THREE RULEBOOKS THAT DECIDE WHAT A SESSION IS WORTH BAND 1 / THE CY 2026 THERAPY THRESHOLD LEDGER $3,000 targeted medical review line, above both pools Applies 2018 through 2028, then indexed to the Medicare Economic Index. Crossing it makes a claim eligible for review, not an automatic audit. $2,480 POOL ONE Physical therapy and speech-language pathology,accruing together against one running balance. $2,480 POOL TWO Occupational therapy, on its own separate balanceof the same amount. A patient in PT and SLP is filling one pool from two directions. Add OT and a second pool opens. Track one balance per patient and the KX attestationarrives late on the shared pool, which is the pool that fills first. BAND 2 / SPEECH TREATMENT AND EVALUATION, TIMED VERSUS UNTIMED UNTIMED, billed once per date of service Session length does not change the line. A long session and a short one produce the same claim. 92507 Treatment of speech, language, voice and communication disorder, individual 92508 The same treatment delivered in a group of two or more individuals 92521 Evaluation of speech fluency 92522 Evaluation of speech sound production 92523 Speech sound production with language comprehension and expression 92524 Behavioral and qualitative analysis of voice and resonance TIMED, 15 minute units These minutes enter the 8-minuteladder with the day's other timedminutes for the discipline. 97129 Cognitive functionintervention, initial 15 minutes 97130 Each additional15 minutes Every one of these carries the GN modifier, which identifies the service as delivered under a speech-language pathology plan of care. BAND 3 / AUDIOLOGY, A SEPARATE DIAGNOSTIC PATH Diagnostic audiology 92550 tympanometry and reflexthresholds, 92557 comprehensiveaudiometry, 92567 tympanometry,92587 and 92588 otoacoustic emissions Two ways in A treating physician or NPP order, ordirect access without an order onceevery 12 months per beneficiary,reported with modifier AB. Paid as a diagnostic test Not therapy. No GN modifier,no plan of care certification,and nothing accrues againsteither therapy pool. The wall: hearing aids, and the examinations performed to prescribe, fit or change them, are excluded from Medicare by statute.That is not a denial to appeal. It is patient responsibility, and it has to be set up as patient responsibility before the visit.

Sources for the exhibit: CY 2026 therapy threshold amounts and the targeted medical review line, CMS therapy services threshold update, consistent with the figures published on the physical therapy billing hub; timed and untimed code behaviour and the 8-minute ladder, CMS Medicare Claims Processing Manual chapter 5, with CPT descriptors from the AMA and 97129 and 97130 confirmed as 15 minute codes in the CY 2023 Physician Fee Schedule final rule, 87 FR 69404; audiology direct access once every 12 months per beneficiary and modifier AB, CY 2023 Physician Fee Schedule final rule, 87 FR 69404, November 18, 2022, amending 42 CFR 410.32(a)(4); hearing aid exclusion, section 1862(a)(7) of the Social Security Act, codified at 42 CFR 411.15(d) and restated by CMS at 79 FR 66120, November 6, 2014.

The rules you are billing under

Six things a speech and audiology practice should know cold.

Each item below carries its source. We do not publish benchmarks we cannot point at. The full treatment of the threshold ledger and the unit arithmetic is in the outpatient therapy revenue integrity whitepaper.

$2,480
CY 2026 KX threshold, PT and SLP

Speech-language pathology and physical therapy accrue against one combined annual threshold. Cross it and every later claim needs the KX modifier plus documentation that the care is still medically necessary. Occupational therapy accrues on a separate threshold of the same amount, so a patient receiving all three disciplines has two running balances, not one and not three.

CMS therapy services threshold amounts, CY 2026; ASHA Medicare reimbursement guidance for speech-language pathology
$3,000
Targeted medical review threshold

The targeted medical review line sits above the KX line and applies for 2018 through 2028, after which it is indexed to the Medicare Economic Index. Crossing it makes a claim eligible for review by the Supplemental Medical Review Contractor. It is not an automatic audit and it is not a payment cap.

CMS therapy services threshold amounts; statutory targeted medical review provision
Untimed
Most SLP treatment and evaluation

92507 individual treatment, 92508 group treatment, 92521 through 92524 evaluation, and 92526 swallowing treatment carry no time designation in the descriptor. They are billed once for the date of service whatever the session length. Duration stops being the variable a reviewer can see, which makes skilled content the only thing left to review.

AMA Current Procedural Terminology descriptors; CMS Medicare Claims Processing Manual, chapter 5
97129 / 97130
The timed side of speech

Therapeutic interventions focused on cognitive function are the codes on the SLP side that genuinely run on 15 minute units, 97129 for the initial 15 minutes and 97130 for each additional 15. Their minutes join the day's timed total for the discipline and run the 8-minute ladder. Nothing else on the untimed list does.

AMA Current Procedural Terminology; descriptors quoted in the CY 2023 Physician Fee Schedule final rule, 87 FR 69404
12 months
Audiology direct access, modifier AB

Since the CY 2023 fee schedule, a defined list of audiology services may be furnished and paid without an order from the treating physician or NPP, for non-acute hearing assessment unrelated to disequilibrium, hearing aids, or examinations to prescribe, fit or change hearing aids. Once every 12 months per beneficiary, reported with modifier AB.

CY 2023 Physician Fee Schedule final rule, 87 FR 69404, November 18, 2022; 42 CFR 410.32(a)(4)
1862(a)(7)
The hearing aid exclusion

Medicare makes no payment where the expense is for hearing aids or examinations for them. The regulation states that hearing aids, and examinations for the purpose of prescribing, fitting or changing hearing aids, are excluded from coverage. The diagnostic test that finds the loss can be covered. The device and the fitting exam are not.

Section 1862(a)(7) of the Social Security Act, codified at 42 CFR 411.15(d); CMS restatement at 79 FR 66120
Run the arithmetic: therapy units calculator for the 8-minute rule, timed against untimed codes, and the de minimis testOpen the therapy units calculator

Revenue leakage taxonomy

The six places speech and audiology revenue actually leaks.

Speech and audiology denials are not random. They cluster into six drivers, and five of the six are settled by a decision made before the claim is ever submitted. This is the taxonomy we work against on every speech and audiology engagement.

Leakage driverHow the dollars go missingThe pre-bill control we installFixable pre-bill
Shared threshold crossed without KXThe PT and SLP pool fills from two directionsA patient receiving both physical therapy and speech therapy fills one combined balance twice as fast as either discipline expects. The SLP claim that crosses the line goes out without the KX modifier and denies, even though the care was necessary and fully documented, because each discipline was watching only its own accrual.A running accrual tracked per patient against the combined PT and SLP pool and against the separate OT pool, with the KX decision forced before the claim is released rather than reconstructed after the denial.Yes
Untimed codes billed as though timedSession length treated as a unit driverA scheduling or billing system that assumes therapy means units will try to derive a unit count from the minutes on an untimed speech treatment or evaluation code. That either inflates the line, which is an overpayment waiting to be found, or produces a productivity report that understates the SLP side and distorts staffing in a multidisciplinary clinic.A code-level timed flag applied at charge entry, so untimed treatment and evaluation lines bill once per date of service and only 97129 and 97130 minutes reach the ladder. Productivity measured in visits for SLP and units for PT and OT, never mixed on one report.Yes
Plan of care certification lapseCertification and recertification calendarSpeech services delivered outside a certified plan of care are exposed, and because the denial arrives weeks later the practice has already spent the clinician hours. Recertification dates slip most often on long-running paediatric caseloads where the family keeps coming and nobody is watching the calendar.A certification calendar that surfaces the recertification window before the visit is scheduled, not after it is delivered, with the signature chase started early enough that the visit is never at risk.Yes
Discipline modifier missingGN on every speech lineSpeech-language pathology services carry the GN modifier identifying the discipline plan of care they were furnished under. A line submitted without it, or with the modifier belonging to another discipline in a clinic that delivers several, denies on a technicality that has nothing to do with the care.The discipline modifier bound to the treating clinician and the plan of care at charge entry, so it cannot be selected wrongly, plus a pre-bill check that no therapy line leaves without one.Yes
Audiology routed as therapyTwo different benefit categoriesDiagnostic audiology is a test, not a therapy service. Billed with a therapy modifier, or fed into the threshold accrual, or held for a plan of care it never needed, it denies or it sits. In the other direction, a test furnished without an order and without the direct access modifier denies for a missing order that was never actually required.A benefit-category split at the front of the workflow that routes audiology to the diagnostic path and speech to the therapy path, with the order or the direct access basis established before the appointment rather than after the test.Yes
Hearing aids and fitting examsA statutory wall, not a denialThe device and the examination performed to prescribe, fit or change it are excluded from Medicare by statute. Billed anyway, they generate a denial that gets worked like an appealable one, consuming follow-up hours on a claim that was never payable, and the money that should have been collected from the patient at the point of service is gone.The exclusion set up as patient responsibility before the visit, with a written financial agreement at scheduling, so the device revenue is collected rather than appealed. What remains for the payer is the covered diagnostic test that identified the loss.Yes

The table describes ASP-RCM's operating taxonomy and the controls we install. It does not assert denial frequencies. Denial mix is measured per practice during the free 30-day audit against the practice's own last 90 days of claim data. Threshold figures are the CY 2026 CMS amounts. The exclusion row reflects section 1862(a)(7) of the Social Security Act as codified at 42 CFR 411.15(d).

The single most expensive assumption in a multidisciplinary clinic: that speech therapy has its own threshold. It does not. It shares one with physical therapy, and occupational therapy is the discipline with the separate pool. A practice that has the pairing backwards attests late on the pool that fills first.

Money map

School-based and clinical, two different claims.

The same paediatric speech session is a different billable object depending on where it happened and what authorised it. The exhibit below separates the two paths, because a practice that runs both and reconciles them on one report will chase the wrong receivable for months.

School-based versus clinical speech billing paths ONE PAEDIATRIC SPEECH SESSION, TWO ENTIRELY DIFFERENT CLAIMS CLINICAL PATH / MEDICAL BENEFIT Referral or direct access Evaluation coded from the92521 to 92524 family, untimed. Plan of care certified Physician or NPP signature,recertified on its own calendar. Treatment, GN on every line Accruing against the combinedPT and SLP threshold pool. Medical benefit pays KX attested above the line,denials appealable. SCHOOL-BASED PATH / STATE MEDICAID PROGRAMME Service written into an IEP The education plan, not aphysician referral, is the trigger. State plan authority Medicaid may pay for coveredservices included in the IEP. State-specific documentation Provider qualifications, logs andclaiming rules set by the state. State Medicaid pays Different rates, different cycle,different appeal route. These two receivables do not age alike, do not deny alike and do not appeal alike. A practice that runs both and reports them on one aged trial balance will spend the quarter chasing whichever one is louder rather than whichever one is older. Separate the two books on day one. Reconcile them separately. Staff them separately.

School-based path sources: Medicaid may pay for covered services included in a child's individualized education program under section 1903(c) of the Social Security Act, with covered services, provider qualifications and claiming rules set by the state Medicaid programme; ASHA school-based service delivery and reimbursement guidance. Clinical path sources: CMS Medicare Benefit Policy Manual, chapter 15, for plan of care certification, and the CY 2026 therapy threshold amounts. Nothing here is a substitute for the applicable state Medicaid manual, which is the controlling document for the school-based path.

Top speech / audiology billing markets by NPPES org count.

State-level RCM guides for the largest speech / audiology billing markets in the U.S.

Florida3,354 orgs → Texas2,626 orgs → California2,216 orgs → New York1,488 orgs → Illinois1,396 orgs → North Carolina1,376 orgs → Georgia1,255 orgs → New Jersey1,165 orgs →

View all 50 state guides →

Speech and audiology billing FAQ

Questions speech and audiology practice owners actually ask.

Does speech therapy share the Medicare therapy threshold with occupational therapy?

No, and getting this backwards is expensive. For calendar year 2026 the threshold is $2,480 for physical therapy and speech-language pathology services combined, and a separate $2,480 for occupational therapy services. Speech shares its pool with physical therapy, not with occupational therapy. A patient receiving both physical and speech therapy fills the shared balance from two directions at once, so it reaches the line sooner than either discipline expects when each one watches only its own accrual. Above the applicable line, later claims must carry the KX modifier attesting that the care remains medically necessary and that the documentation supports it. The threshold is an attestation trigger, not a cap and not a denial.

Does the 8-minute rule apply to speech-language pathology?

Only to the small timed part of it. Most speech treatment and evaluation codes carry no time designation in the descriptor and are billed once for the date of service regardless of session length, which means a fifty minute session and a twenty five minute session produce the same claim line. That covers 92507 individual treatment, 92508 group treatment, the 92521 through 92524 evaluation family and 92526 swallowing treatment. The codes that genuinely run on 15 minute units are the cognitive function interventions, 97129 for the initial 15 minutes and 97130 for each additional 15, and those minutes do join the day's timed total and run the ladder. The practical consequence is that duration stops being the variable a reviewer can see on most speech lines, which makes the skilled content of the note the only thing left to review.

What is the targeted medical review threshold and does crossing it mean an audit?

The targeted medical review threshold is $3,000 and it sits above the KX line. It applies for 2018 through 2028, after which it is indexed to the Medicare Economic Index. Crossing it makes a claim eligible for review by the Supplemental Medical Review Contractor, but review is targeted rather than automatic: selection weights providers with high denial rates, unusual billing patterns and other risk signals. The defence is the same discipline that keeps the KX line clean, which is documentation showing measurable progress toward the goals in the certified plan of care.

Can an audiologist bill Medicare without a physician order?

For a defined list of services, yes, and since the CY 2023 fee schedule this has been settled policy. CMS finalised that certain audiology services may be covered and paid when furnished without an order from the treating physician or non-physician practitioner, for non-acute hearing assessment unrelated to disequilibrium, hearing aids, or examinations for the purpose of prescribing, fitting or changing hearing aids. The services may be performed once every 12 months per beneficiary and are reported with modifier AB rather than a bundled G-code. The rule was published at 87 FR 69404 on November 18, 2022 and the requirement now sits in the regulation at 42 CFR 410.32(a)(4). Everything outside that list and that frequency still needs the order.

Does Medicare cover hearing aids?

No, and this is a statutory exclusion rather than a coverage judgement, which changes how a practice should handle it. Section 1862(a)(7) of the Social Security Act states that no payment may be made where the expenses are for hearing aids or examinations for them, and the policy is codified at 42 CFR 411.15(d), which excludes hearing aids and examinations for the purpose of prescribing, fitting or changing hearing aids. The diagnostic test that identifies the hearing loss can be a covered service. The device and the fitting examination are not. Because the line was never payable, a denial on it is not an appeal opportunity, and every follow-up hour spent working it is wasted. The right control is a written financial agreement at scheduling so the revenue is collected from the patient rather than pursued from the payer.

How does school-based speech billing differ from clinical billing?

They are two different claims with two different authorities behind them. On the clinical path the trigger is a referral or direct access, the plan of care is certified by a physician or non-physician practitioner, treatment carries the GN modifier and the charges accrue against the combined physical therapy and speech-language pathology threshold. On the school-based path the trigger is the service written into the child's individualized education program, and Medicaid may pay for covered services included in that plan under section 1903(c) of the Social Security Act, with covered services, provider qualifications, documentation and claiming rules set by the state Medicaid programme rather than by Medicare. The two receivables do not age alike, do not deny alike and do not appeal alike, so a practice running both should keep two books and reconcile them separately from day one.

Which speech and audiology denials are preventable before submission?

Nearly all of the high-volume ones. A missing KX modifier above the shared threshold, a lapsed certification or recertification, a missing or wrong discipline modifier, an untimed code billed as though session minutes drove units, an audiology test routed down the therapy path, and a hearing aid line that was never payable are every one of them knowable before the claim goes out, because the information already sits in the treatment note, the certification calendar, the running threshold accrual and the benefit-category decision made at scheduling. What is left after those controls is a small set of genuine medical necessity disputes, which is what an appeals function is actually for.

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Speech Audiology billing by state.

Dedicated Speech Audiology billing and credentialing field guides for 51 states. Each state guide opens into its city-level guides with local payer, Medicaid, and credentialing detail.