CPT Code Guide · April 2026

CPT 92523: Speech and Language Evaluation Billing Guide for SLPs

CPT 92523 is the highest-reimbursing evaluation code in the SLP code set — and the one most likely to get your practice flagged for upcoding. It covers the evaluation of speech sound production combined with evaluation of language comprehension and expression. Understanding when to bill it, when not to, and what documentation is required can be the difference between clean claims and a MAC audit.

What 92523 Requires — Both Components

The defining feature of 92523 is that it bundles two distinct assessment components into a single code:

1. Speech sound production evaluation — assessment of articulation, phonological processes, motor speech function, and/or intelligibility
2. Language comprehension and expression evaluation — assessment of receptive language, expressive language, pragmatic language, and/or narrative skills

Both components must be performed AND documented. If you only assessed speech production without evaluating language, the correct code is 92522. If you only assessed language without evaluating speech production, there is no single standalone code — you would need to use 92523 only if both were genuinely assessed.

Why OIG Is Watching 92523

OIG Work Plan data shows that SLP evaluation code distribution is statistically skewed toward 92523 across the Medicare population. In other words, more SLPs are billing the comprehensive evaluation code than the clinical population would justify. MAC audit data from 2025 confirms that 92523 upcoding is among the top three SLP billing issues triggering post-payment review.

The pattern that triggers scrutiny: if your practice bills 92523 on more than 70–80% of evaluations while rarely or never billing 92521, 92522, or 92524, your claims profile is a statistical outlier. Not every patient who walks through your door needs a combined speech-and-language evaluation, and your billing should reflect that clinical reality.

Documentation That Supports 92523

When you do bill 92523, CMS guidance indicates your evaluation report should clearly demonstrate:

• Separate speech production findings: Results of articulation assessment, phonological analysis, or motor speech examination with specific data (error patterns, intelligibility ratings, stimulability results)
• Separate language findings: Results of receptive and expressive language assessment with specific data (standardized test scores, language sample analysis, comprehension task results)
• Distinct assessment tools or procedures for each component: You don't need to use a standardized test for both, but the evaluation methods should be clearly identifiable and separate
• Clinical impression addressing both domains: Your diagnostic statement should reference findings from both the speech production and language assessment
• Recommendations that reflect both areas: Treatment recommendations should flow logically from the evaluation findings in both domains

92523 vs. 92522: Making the Right Call

The decision between 92523 and 92522 should be made based on what you actually assessed — not based on reimbursement or habit. Here's the clinical decision framework:

• Bill 92522 when the referral is specifically for speech sound production concerns and you assessed articulation, phonology, or motor speech without conducting a systematic language evaluation
• Bill 92523 when the clinical picture warranted assessment of BOTH speech production AND language, and you performed and documented distinct evaluation procedures for each
• Never bill 92523 by default — the code selection should be driven by the clinical question being answered, not by which code pays more

What Happens When 92523 Fails Audit

When a MAC auditor reviews a 92523 claim and determines the documentation only supports one component, the typical outcome is a downcode to 92522 with recoupment of the difference. If the review finds a systemic pattern of unsupported 92523 billing, the MAC may extrapolate the error rate across all evaluation claims in the review period — which can result in significant financial exposure.

Best practice suggests auditing your own evaluation code distribution quarterly. Pull a report showing your breakdown of 92521, 92522, 92523, and 92524 billing. If the distribution doesn't reflect your actual clinical population mix, it's worth reviewing the documentation on a sample of 92523 claims to confirm they support the code level.