CPT code 92507 is undergoing a valuation review.  This does not mean it will definitely change, and any changes would not take effect until January 2027.  However, it is in all of our best interests as SLPs to become educated on this issue and get involved in sharing our expertise.   CLICK HERE for a PDF of the information below. 

BASIC INFORMATION YOU NEED TO KNOW

• CPT 92507 remains unchanged until January 1, 2027

• The CPT code 92507 is currently undergoing coding and valuation review through:

• • American Medical Association (AMA) CPT process

  • CMS Medicare Physician Fee Schedule process
    
    

• These reviews occur as:

• • Utilization patterns change

  • Clinical practice evolves
    
    

• Reported purpose of changes:

• • Better reflect current clinical practice

  • Align coding with real-world service delivery
    
    

• What is needed from clinicians:

• • Clearly describe current clinical practices

  • Provide insight into how proposed changes will impact care and workflow
    
    

• Survey from the fall 2025:

• • A survey was distributed to some SLPs nationwide in the fall of 2025

  • Survey provided selected clinicians an opportunity to provide feedback on proposed code set changes for 92507 related to work RVUs

  • The intent was unclear, with a lower-than-expected response

  • Many SLPs expressed a lack of awareness and inclusion in the proposed changes and process
    

• Timeline moving forward with proposed coding and valuation changes:

• • A Code Change Application has been submitted for review at the April 30–May 2, 2026 CPT Editorial Panel Meeting

  • Interested parties may register on the AMA website to submit written comments between March 6–31

  • Once registered and the terms and conditions documents are signed, agenda materials will be available to “commenters” on the AMA website

  • If interested in being involved in the hybrid format meeting (in-person & virtual) on April 30-May 2, register on the AMA website as well

  • Final details expected Summer–Fall 2026
    
    

• Support for clinicians:

• • This process is complex, but input from many SLPs is important

  • Guidance and resources will be provided as available

  • Step-by-step instructions for the registration process upcoming

• Important note:

• • ASHA is sharing information only

  • Direct questions should go to AMA
    
    

RELEVANT BACKGROUND INFORMATION ABOUT CODING AND BILLING

TIMED VS. UNTIMED CODES

• The Right Time for Billing Codes: Here’s what you need to know about billing timed and untimed evaluation and procedure codes.: The ASHA Leader Archive: Vol 23, No 3

• Important for:

• • Documentation

  • Billing accuracy

  • Compliance
    
    

CURRENT TIME STRUCTURE FOR 92507

• Approximate total: 60 minutes

• See CMS-1676-F | CMS for more code information on the underlying rules of how much time should be spent per code.

• • 5 min pre-service

  • 50 min direct treatment

  • 5 min post-service
    
    

MEDICARE 8-MINUTE RULE (15-MINUTE CODES)

This applies to other timed codes, such as 97129/97530, for reference about timed code usage

• 0–7 min → 0 units

• 8–22 min → 1 unit

• 23–37 min → 2 units

• 38–52 min → 3 units

• 53–67 min → 4 units

• 68–82 min → 5 units

• 83–97 min → 6 units
  
  

WHAT IS AN RVU?

Definition and Purpose

• RVU = Relative Value Unit

• Measures value of medical services based on:

• • Time

  • Effort

  • Skill

  • Risk

• Used in:

• • Medicare Physician Fee Schedule

  • Payment standardization across services

• Helps:

• • Determine reimbursement

  • Track productivity

  • Align clinical work with financial metrics

Components of an RVU

• Work RVU (wRVU):

• • Time, effort, technical skill, stress

• Practice Expense RVU (peRVU):

• • Staff, equipment, overhead

• Malpractice RVU (mpRVU):

• • Liability insurance cost

• Total RVU = wRVU + peRVU + mpRVU

• • Adjusted geographically

  • Converted to payment via conversion factor
    
    

HOW RVUs AFFECT COMPENSATION

• Used in RVU-based pay models

• Higher complexity services → higher RVUs

• May include:

• • Productivity benchmarks

  • Incentive thresholds

RECENT PROPOSED INFORMATION BELOW

• This is a proposal only - not definitive

• Current 92507 work RVU = 1.3

Proposed Structure of potential code set:

Fluency Treatment

• Initial 30 minutes: 0.92 wRVU

• Each additional 15 min: 0.44 wRVU
  
  

Speech Sound Production

• (articulation, phonology, apraxia, dysarthria)

• Initial 30 min: 0.90 wRVU

• Each additional 15 min: 0.44 wRVU
  
  

Language (Comprehension & Expression)

• First 30 min: 1.00 wRVU

• Each additional 15 min: 0.48 wRVU
  
  

Speech Sound + Language Combined

• First 30 min: 1.00 wRVU

• Each additional 15 min: 0.50 wRVU
  
  

Voice / Upper Airway / Resonance

• First 30 min: 0.98 wRVU

• Each additional 15 min: 0.48 wRVU
  
  

POTENTIAL INFORMATION AND CONCERNS FOR WRITTEN RESPONSES

• Why use 30-minute base + 15-minute increments, instead of all 15-minute units (like OT/PT)?
  
  

• Missing or unclear scope areas:

• • Auditory Processing Disorder

  • Literacy

  • Social Communication
    
    

• Concerns about complexity not captured:

• • Pediatric vs adult populations

  • Medically complex cases

  • Multi-domain impairments
    
    

• Questions:

• • Should there be separate codes for complexity levels?

  • Are child vs adult distinctions still being considered?
    
    

• wRVU concern:

• • Combined treatment = same as language-only

  • Does not reflect increased complexity
    
    

• Structural questions:

• • Can codes be combined in one session?

  • Will group therapy remain unchanged?

  • Can codes combine with:

  • • Cognitive codes

    • Swallowing codes

    • Other appropriate codes
      
      

• Billing rule concerns:

• • Will codes follow 51% rule or the full-time requirement?

  • Example:

  • • 16 minutes of a “30-minute” code → billable or not?
      

WHAT YOU NEED TO COMMUNICATE TO MAKE A DIFFERENCE

• This is a key opportunity for clinician input before decisions are final

• AMA needs clinician input to shape the policy for the Descriptor (what the code describes)

• Emphasize:

• • Multi-domain treatment in single sessions

  • Integrated therapy approaches

  • Need for flexibility
    
    

• Do NOT focus on reimbursement rates

• • AMA does NOT determine payment

INFORMATION TO INCLUDE IN COMMENTS

• Clinical reasoning and real-world practice

• Workflow realities

• Patient care considerations

• Documentation and coding challenges

• Potential unintended consequences
  
  

WHY CODE STRUCTURE MATTERS

AMA decides the code structure. Code structure is critical because it impacts how care is delivered and documented:

• Impacts:

• • Documentation requirements

  • Data tracking

  • Productivity expectations

  • Staffing decisions

  • Code utilization

  • Audit risk
    

NEXT STEP: VALUATION PROCESS

• After the structure is determined → valuation (RUC process)
  Includes:

• • Time requirements

  • Work involved

  • Clinical complexity

  • Practice expense
    
    

• Determines:

• • RVUs
    
    

FINAL STEP: REIMBURSEMENT (Not determined by AMA)

• Determined by:

• • Medicare (CMS)

  • Medicaid

  • Private insurers
    
    

• Includes:

• • Payment rates

  • Coverage rules

  • Authorization policies
    
    

• Key point:

• • AMA defines structure and valuation

  • Payers determine reimbursement
    
    

More information will be provided following a meeting with ASHA that will include STARS/STAMPS representatives, state association presidents, and other selected positions on March 23rd. 

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