Reimbursement Guide · April 2026

Speech Therapy Billing Codes and Reimbursement Rates: 2026 Guide

Understanding what Medicare pays for each SLP service is essential for setting your fee schedule, forecasting revenue, and identifying underpayments. This guide covers the current Medicare Part B reimbursement landscape for the CPT codes SLPs use most frequently.

2026 Medicare Reimbursement Rates for SLP Codes

The following table shows approximate national average Medicare Part B reimbursement rates for common SLP CPT codes. Actual rates vary by locality (geographic practice cost index) and by MAC. These are non-facility (office/private practice) rates.

Why 92523 Reimburses Higher — and Why That Matters

Notice that 92523 ($145–$185) reimburses significantly more than 92521, 92522, or 92524 ($85–$110). This is because 92523 bundles two evaluation components — speech production AND language comprehension/expression — into a single code. The higher reimbursement reflects the increased clinical complexity and time.

This reimbursement gap is also what makes 92523 the most common upcoding target in SLP billing. OIG has flagged practices that default to 92523 for every evaluation regardless of the clinical presentation. The code you bill should always match the assessment you actually performed — not the one that pays the most.

Setting Your Fee Schedule

Your practice's fee schedule (the amount you charge before insurance adjustments) should be set above the highest payer's allowed amount to ensure you're never leaving money on the table. Best practice suggests setting fees at 150–200% of the Medicare rate for each code. This ensures that if a commercial payer reimburses above Medicare rates, you capture the full allowed amount.

For example, if Medicare pays $85 for 92507 in your locality, your fee schedule might list 92507 at $170. The payer will adjust to their allowed amount, but if you set your fee at $85 and a commercial payer's allowed amount is $120, you'd only receive $85 because your charge was the limiting factor.

Understanding the Conversion Factor

Medicare reimbursement rates are calculated using the formula: RVU × Conversion Factor × GPCI. The Relative Value Unit (RVU) is set by code. The Conversion Factor is updated annually and applies to all codes. The Geographic Practice Cost Index (GPCI) adjusts for your locality.

When CMS updates the Conversion Factor each January, all SLP reimbursement rates shift proportionally. A decrease in the conversion factor means lower reimbursement across the board. SLPBillingClarity tracks these annual changes and alerts you to the specific dollar impact on each code you bill.

Commercial Payer Reimbursement

Commercial payers (UnitedHealth, Aetna, Cigna, BCBS, etc.) each negotiate their own reimbursement rates, which may be higher or lower than Medicare. Common patterns:

• UnitedHealth/Optum — Rates typically track close to Medicare, sometimes 5–10% above
• BCBS — Varies significantly by state plan; some BCBS plans reimburse 20–30% above Medicare
• Aetna — Generally at or slightly above Medicare rates for SLP services
• Cigna — Rates vary by contract; newer credentialed providers may receive lower rates initially
• Medicaid — Rates are typically 10–40% below Medicare, varying significantly by state

If you're credentialed with multiple payers, knowing each payer's reimbursement rate for your top codes helps you understand which payers are most valuable to your practice and where to focus your scheduling.

Tracking Reimbursement Changes

Reimbursement rates change annually at minimum — and sometimes mid-year through legislative action or fee schedule corrections. The key events to track include the January Physician Fee Schedule update (affects all Medicare rates), mid-year legislative adjustments (Congress has intervened to prevent scheduled rate cuts multiple times), commercial payer fee schedule updates (which can happen at any contract renewal), and state Medicaid fee schedule changes (which vary by state legislative calendar).