CPT Code Guide · April 2026

CPT 92524: Voice and Resonance Evaluation Billing Guide for SLPs

CPT 92524 covers the behavioral and qualitative analysis of voice and resonance. It's the evaluation code used when an SLP assesses a patient for voice disorders — hoarseness, vocal fatigue, pitch abnormalities, resonance issues, or other changes in vocal quality. While it's less commonly billed than 92523 or 92507, it has its own documentation requirements and billing nuances that SLPs need to understand.

What 92524 Covers

The code is defined as "behavioral and qualitative analysis of voice and resonance." This includes assessment of:

• Perceptual voice quality analysis — roughness, breathiness, strain, pitch, loudness, and overall severity using a standardized rating scale (CAPE-V or GRBAS)
• Acoustic analysis — if performed, measurements of fundamental frequency, jitter, shimmer, harmonics-to-noise ratio, and other acoustic parameters
• Aerodynamic assessment — maximum phonation time, s/z ratio, and respiratory support for phonation
• Resonance evaluation — assessment of hypernasality, hyponasality, or mixed resonance
• Vocal behavior assessment — patterns of voice use, vocal abuse/misuse behaviors, and environmental factors affecting voice
• Functional impact — how the voice disorder affects the patient's communication, occupation, and quality of life

Documentation That Supports 92524

For a 92524 claim to survive post-payment review, your evaluation should document:

• Reason for referral — the clinical indication (laryngologist referral, teacher with vocal fatigue, post-surgical voice change, etc.)
• Perceptual voice quality ratings — using CAPE-V or GRBAS with specific ratings for each parameter, not just "voice sounds hoarse"
• Objective measures — at minimum, maximum phonation time and s/z ratio; ideally, acoustic measurements if instrumentation is available
• Vocal behavior inventory — documentation of voice use patterns, hydration, environmental irritants, and vocal hygiene habits
• Resonance findings — if applicable, assessment of velopharyngeal function and nasalance
• Clinical impression — diagnosis of the voice disorder type and severity, correlated with any ENT/laryngoscopy findings if available
• Treatment recommendations — voice therapy plan, vocal hygiene program, referral for laryngoscopy if not yet completed, or recommendation for no treatment with rationale

92524 vs. 92523: Don't Default Up

If a patient is referred for a voice disorder and you perform a voice evaluation, bill 92524. Do not default to 92523 (which covers speech production + language) simply because it reimburses higher. The evaluation code must match the clinical domain assessed.

If the patient presents with both voice concerns AND speech/language concerns, and you conducted separate assessments of both domains, it may be appropriate to bill 92524 and 92523 on the same date — but NCCI edit pairs may require modifier -59 or XE, and the documentation must clearly support distinct evaluation procedures for each code.

Modifier Requirements

• -GN modifier — Required on all SLP services billed to Medicare Part B
• -KX modifier — Required if the patient is above the therapy cap threshold
• -59 or XE — May be needed when billing alongside other evaluation or treatment codes on the same date

Voice Evaluation and Telehealth

Voice evaluations present a unique telehealth challenge. Perceptual voice quality assessment can be affected by microphone quality, internet bandwidth, and audio compression — all of which may distort the acoustic signal. Acoustic analysis via telehealth requires the patient to have appropriate recording equipment, which is rarely available in home settings.

CMS guidance indicates that 92524 is on the Medicare telehealth services list, but the clinical validity of a remote voice evaluation depends heavily on audio quality. Best practice suggests documenting the technology used and any limitations it imposed on the assessment. If audio quality was insufficient for reliable perceptual ratings, document that finding and consider recommending an in-person follow-up evaluation.

Common Billing Errors with 92524

• Billing 92524 for a voice screening: A brief voice quality check as part of an oral mechanism exam is not a voice evaluation. 92524 requires a comprehensive assessment focused on voice and resonance.
• Missing perceptual ratings: "Voice sounds hoarse" is an observation, not an evaluation finding. Use CAPE-V or GRBAS with specific parameter ratings.
• No objective measures: While not strictly required by the CPT code definition, MAC auditors increasingly expect at least basic objective measures (MPT, s/z ratio) to support a comprehensive voice evaluation claim.
• Billing 92524 without ENT correlation: If the patient has vocal fold pathology identified on laryngoscopy, reference those findings in your evaluation. If no laryngoscopy has been performed, document the referral. The absence of both creates a documentation gap.