Two disciplines, one shared clock, and a separate lane for audiology.
Speech-language pathology and physical therapy draw from the same annual dollar threshold. Audiology diagnostics do not. Get the split wrong and you leave clean claims sitting in denial queues.
Under the CMS Calendar Year 2026 Physician Fee Schedule (PFS) final rule, PT and SLP services share a single combined KX modifier threshold per beneficiary per year. Every SLP treatment dollar you bill draws down the same pool a PT provider is drawing from. Audiology diagnostic testing is not a therapy service, so it never touches that threshold and can move through 2026 direct-access and CAPD rules on its own track.
The numbers that govern the year
Four thresholds that decide whether an SLP or audiology claim pays
These are the guideposts your billing logic has to respect. The dollar amounts are indexed each year in the PFS final rule; the CY2025 published baseline is shown where CY2026 figures follow the same mechanism.
A year on the shared clock
Watch SLP charges consume the shared PT/SLP threshold, then see where audiology breaks away
Read it top to bottom. The blue and gold nodes are the therapy pool your SLP claims share with PT. The cyan node is the audiology track that runs beside it under its own 2026 rules.
The combined clock starts at zero
Every beneficiary gets one shared PT + SLP pool for the year. A patient who saw PT in December starts fresh, and so does your SLP caseload. Nothing is billed against the threshold yet.
92507 · 92523 · 92526 all count herePT and SLP dollars stack in the same bucket
This is the trap. A patient in PT for a shoulder and in SLP for dysphagia is drawing from one limit. Your SLP claims may look nowhere near a cap on their own, yet the combined total is already climbing toward the KX line.
Append KX and keep billing
Once combined incurred expenses pass the KX threshold, the KX modifier goes on medically necessary SLP and PT claims to attest the services still meet coverage criteria. It is an attestation, not a hard stop. Miss it above the line and the claim denies for the modifier, not the medicine.
Modifier KX on qualifying linesTargeted medical review may attach
Combined therapy above $3,000 can be selected for targeted medical review. This is not automatic and not a cap. Your documentation, your plan of care, and your justification for continued care are what carry the claim. The $3,000 figure is frozen through CY2027.
Bipartisan Budget Act of 2018Audiology direct access runs beside the pool, not inside it
Audiology diagnostic testing is not a therapy service, so it is never counted against the PT/SLP threshold. Under the CY2026 PFS direct-access framework, an audiologist may furnish certain diagnostic tests without a physician order, reported with the AB modifier, once per 12 months per patient. Central auditory processing testing lives here too.
AB modifier · 92620 · 92621The line that trips most billers
Therapy counts against the threshold. Audiology diagnostics do not.
If your edits treat every code from an SLP or audiology encounter the same way, you are either over-applying KX or missing direct-access rules. Keep these two lanes physically separate in your logic.
Counts to the pool SLP therapy services
92507treatment of speech, language, voice, communication92508group speech/language treatment92521–92524evaluation of fluency, sound production, language, voice92526treatment of swallowing and oral feeding- Draws from the same annual limit as PT; needs KX above the threshold
Outside the pool Audiology diagnostics
92620 / 92621central auditory processing (CAPD) evaluation- Diagnostic tests, not therapy, so no KX threshold applies
- Direct access with the
ABmodifier, no physician order, once per 12 months - Reported by the audiologist under the CY2026 PFS provisions
- Ordered audiology tests continue under standard order rules
Side by side
How the three therapy pools and the audiology track actually differ
| Service line | Threshold pool | KX modifier | Key 2026 rule |
|---|---|---|---|
| Speech-language pathology | Shared with PT | Required above the combined threshold | Same limit as PT per beneficiary per year |
| Physical therapy | Shared with SLP | Required above the combined threshold | Same limit as SLP per beneficiary per year |
| Occupational therapy | Separate OT pool | Required above the OT threshold | Its own limit, never mixed with PT/SLP |
| Audiology diagnostics | No therapy threshold | Not applicable | Direct access with AB modifier, once per 12 months |
Where the visit happens matters too
SLP telehealth codes still ride the shared threshold
Speech-language pathologists are eligible Medicare telehealth practitioners for services on the Medicare Telehealth Services List. A telehealth SLP claim counts against the shared PT/SLP threshold exactly like an in-person one, so the place of service changes the modifiers, not the pool.
Stop losing clean SLP and audiology claims to the wrong lane.
ASP-RCM builds the KX threshold logic, the audiology direct-access and CAPD rules, and the telehealth place-of-service edits into one billing workflow, so a shared-pool patient never trips a denial your team has to rework. We run the CY2026 PFS rules for you and reconcile every line.
Talk to our speech and audiology billing team → Request a threshold auditSources cited by name: CMS Calendar Year 2026 Medicare Physician Fee Schedule (PFS) final rule; Medicare combined PT and SLP KX modifier threshold (CY2025 published baseline $2,410, updated annually via the Medicare Economic Index); targeted medical review threshold of $3,000 set by the Bipartisan Budget Act of 2018 and held through CY2027; audiology direct-access provisions and the AB modifier under the Medicare PFS; CPT 92620 and 92621 for central auditory processing (CAPD) evaluation; and the Medicare Telehealth Services List for SLP telehealth codes. Figures reflect published Medicare guidance; confirm the exact CY2026 dollar amounts against the current PFS final rule before filing. This page is billing guidance, not legal or coverage advice.
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