What payers look for on a speech therapy superbill
An insurer reviewing a speech-language pathology claim is really asking two things: is this a covered medical service, and did a qualified clinician deliver it? Your superbill answers the second question with your credentials (for example MA, CCC-SLP), your state license number and your NPI. It answers the first with diagnosis codes that describe a functional communication or swallowing problem rather than an academic concern, and with a clean list of evaluations and treatment dates.
Many SLPs list two kinds of diagnoses. The medical diagnosis explains the cause, such as vocal fold nodules (J38.2). The treating diagnosis describes what therapy actually targets, such as dysphonia (R49.0). For aphasia after a stroke, ICD-10-CM combines both ideas into one code, I69.320, which is used instead of R47.01. The generator above holds up to 12 diagnoses lettered A through L, so you can include both kinds and point each service line at the ones that apply.
Common speech-language pathology codes
| Code | What it covers | When to use it |
|---|---|---|
| 92521 | Fluency evaluation | Stuttering or cluttering assessments |
| 92522 | Speech sound production evaluation | Articulation, phonology, apraxia or dysarthria without a language battery |
| 92523 | Speech sound plus language evaluation | Speech sounds and receptive or expressive language assessed together; replaces 92522 |
| 92524 | Voice and resonance evaluation | Dysphonia, hypernasality and other voice or resonance concerns |
| 92610 | Clinical swallowing evaluation | Clinic or bedside assessment of oral and pharyngeal swallowing |
| 96105 / 96125 | Aphasia assessment / cognitive testing | Standardized aphasia batteries or cognitive-communication testing, per hour |
| 92507 | Individual treatment | Speech, language, voice, fluency or auditory processing therapy |
| 92508 | Group treatment | Two or more clients treated together |
| 92526 | Swallowing or feeding treatment | Dysphagia therapy and pediatric feeding intervention |
| 97129 / 97130 | Cognitive intervention | Attention, memory and executive function therapy in 15-minute units |
| 92607 / 92609 | AAC evaluation / device training | Speech-generating device assessment, then programming and training sessions |
Untimed sessions versus timed units
Most SLP codes are untimed. 92507, 92508 and 92526 are reported as one unit per date of service no matter how long the session runs, and the evaluation codes 92521 through 92524 and 92610 are also one unit each. Write the session length in your notes anyway; it supports medical necessity and helps if a plan imposes minimum durations.
A few codes do count time. 96105 and 96125 are billed per hour, and most payers follow the CPT convention that a unit is earned once you pass the midpoint. 97129 covers the first 15 minutes of cognitive intervention and is reported once per day, with 97130 for each additional 15 minutes, so a 45-minute cognitive session is one unit of 97129 plus two units of 97130. AAC evaluation time works the same way: 92607 for the first hour, with 92608 as its add-on for each additional 30 minutes.
There is no separate re-evaluation code for speech-language pathology. Payers generally expect the relevant evaluation code again, so check whether the plan limits evaluations per year before scheduling a formal re-test.
Modifiers, place of service and teletherapy
GN identifies the service as speech-language pathology. Medicare requires it, and many other payers use it to sort therapy claims. KX matters only for Medicare clients whose combined PT and speech therapy spending for the year has passed the annual threshold. Some payers bundle 92507 and 92526 on the same date unless you document clearly separate treatment and add 59 or an X modifier.
Use POS 11 for your clinic, 12 for home visits and 03 for private sessions held at a school. For video sessions, many plans want POS 10 (patient at home) or 02 (patient elsewhere) along with modifier 95, though rules differ by payer. Our guide to telehealth place of service codes explains the difference.
Documentation that supports reimbursement
- Standardized test names, scores and percentile ranks from the evaluation.
- Functional, measurable goals tied to the diagnosis, such as intelligibility in conversation or safe intake of thin liquids.
- A plan of care with frequency and duration, plus the physician signature or referral when the plan requires one.
- Session notes showing skilled intervention and progress toward each goal.
- For feeding and swallowing, the textures and liquids trialed, strategies used and any instrumental study results.
Coverage gotchas specific to speech therapy
Speech therapy benefits vary more than most. Some policies cover only rehabilitative care that restores lost function, which can exclude developmental delays. Others cap visits per year and share that cap with physical and occupational therapy, require a prescription before the first visit, or need prior authorization after the evaluation. Services delivered through a school IEP are not something the family should be billing. Medicare is a separate system altogether: beneficiaries generally cannot get reimbursed by filing their own superbill, so this template is built for commercial out-of-network claims and private-pay records.
How to fill in this speech therapy superbill
- Enter your practice details, name and credentials, license number, NPI and EIN. The NPI field checks the check digit so typos are caught early.
- Add the client’s name, date of birth, address and insurance carrier, member ID and group number.
- Enter the medical and treating diagnoses. Start typing a code and the field suggests common SLP codes and fills in the description.
- Add one service line per visit with the date, CPT code, GN modifier if the plan uses it, place of service, diagnosis pointer, units and fee.
- Record the amount paid; the balance calculates automatically.
- Type your signature, add any notes (for example, that a signed plan of care is on file), and review the checklist for missing fields.
- Click Print / Save as PDF to produce a US Letter superbill.
If you bill a full caseload each month, the EHR CSV import matches your export’s columns and batch prints one superbill per client.
Create your speech therapy superbill
Fill in the generator above to build a superbill your clients can submit with confidence. Not sure what else belongs on the page? Read what to include on a superbill and how to submit a superbill to insurance. If you work alongside rehab colleagues, the occupational therapy superbill template follows the same format.