Article Rating

  • 0 Rating(s)
  • 0
  • 0
  • 0
  • 0
  • 0

Untimed Speech Therapy CPT Codes

It has come to our attention that some EI Billing Providers are receiving commercial insurance denials due to incorrect unit designations in their coding for certain speech-language therapy services. Below is information on how to correct the issue.

The Current Procedural Terminology (CPT®) system, developed by the American Medical Association, is designed to ensure that health care data is captured accurately and consistently and to facilitate proper processing of claims for health services. In accordance with coding guidance from the American Speech-Language-Hearing Association (ASHA), CPT codes 92507 (Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual) and 92526 (Treatment of swallowing dysfunction and/or oral function for feeding) have no time designation. Each therapy session is billed as one procedure (1 unit) regardless of length of session. Multiple units should not be reported when using CPT code 92507 or CPT code 92526. More information regarding CPT coding for Speech-Language Pathology services can be found at

Billing providers manually entering claims in NYEIS with either of these CPT codes should check the number of units prior to finalizing claim submission. If multiple units are reported with CPT code 92507 or 92526, modify the units to “1” prior to finalizing claim submission in NYEIS. Electronic billers should verify the 837 includes the appropriate unit count when utilizing these procedure codes.

Below are examples of correct and incorrect methods for reporting these procedure codes on claims in NYEIS:

Correct number of units:

Showing only one unit

Incorrect number of units:

Showing two units

For claims already submitted and finalized in NYEIS with the incorrect number of units that are still pending adjudication from commercial insurance or Medicaid, please contact PCG to manually adjust the claim(s) to reflect the correct units.

If you have any questions regarding claiming functionality in NYEIS, please contact the NYEIS Help Desk (518) 640-8390 or toll free at 1-833-395-7058.

Article ID: 408, Created On: 5/1/2019, Modified: 5/7/2019

Feedback (0)