CPT code 92521

92521 CPT code, CPT code 92521

92521 CPT code refers to the evaluation of speech fluency. It is an important CPT code that speech-language pathologists (“SLPs”) often encounter. The 92521 CPT code is used when assessing speech fluency disorders, such as stuttering and cluttering.

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CPT (Current Procedural Terminology) codes are numeric codes that are used to identify services and procedures performed by healthcare providers. A thorough understanding and correct use of CPT codes is essential to ensure appropriate billing, reimbursement, and compliance with healthcare regulations.

Let’s explore 92521 CPT code, including its purpose, appropriate use, and best practices to follow for ensuring proper documentation and billing.


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What is CPT Code 92521?

CPT Code 92521 refers to “the evaluation of speech fluency.” This is an assessment completed by a speech-language pathologist to identify the presence and severity of fluency disorders.

Fluency disorders include:
  • Stuttering: An interruption in the flow of speaking. This is the most common type of fluency disorder.

  • Cluttering: A fluency disorder characterized by a perceived rapid and/or irregular speech rate, atypical pauses, maze behaviors, pragmatic issues, and other symptoms.

The evaluation process covered by 92521 CPT code typically includes a comprehensive assessment of the patient’s speech patterns through informal and formal assessment methods. The SLP may obtain a speech sample and utilize a standardized assessment such as the Stuttering Severity Instrument - 4th Edition (SSI-4). Other diagnostic tools such as questionnaires for the patient and family, and speech rating scales, may also be used.

The SLP typically assesses the rate, rhythm, and presence of disfluencies. If disfluencies are noted, the therapist often calculates the percentage of syllables stuttered and characterizes the types of dysfluencies (ex, part-word or whole word). Any physical behaviors that accompany a patient’s disfluencies are also observed and reported.


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When to use the 92521 CPT code

92521 CPT code should be used when the speech-language pathologist evaluates a patient for the presence of a speech fluency disorder. This evaluation may be indicated when a fluency problem such as stuttering or cluttering is suspected.

The patient being evaluated may be referred specifically due to concerns regarding speech fluency. Or, concerns may arise as part of a broader assessment in which the patient’s speech and language skills are being evaluated.

Appropriate scenarios where the 92521 CPT code might apply include:
  • Developmental stuttering: A fluency disorder that typically begins in childhood, when children are still learning speech and language skills.

  • Acquired stuttering: A fluency disorder that develops later in life, typically due to trauma or neurological conditions.

  • Cluttering: A fluency disorder that is characterized by irregular, rapid speech and frequent disfluencies.

Speech therapists must be sure to fulfill certain documentation requirements in order to accurately bill for 92521 CPT code.

This includes:
  • Patient history: A detailed history of the patient’s medical history and history of the onset of stuttering.

  • Fluency assessment: A combination of standardized and informal assessment procedures to assess the patient’s fluency, including the types and frequency of disfluencies.

  • Evaluation results: A detailed description of the results of the assessment, including the patient’s areas of strengths and difficulties with regards to speech fluency.

  • Diagnosis: If present, the SLP documents a diagnosis and severity of the fluency disorder using the appropriate ICD-10 code (ex: F80.81 Childhood onset fluency disorder or F98.5 Adult onset fluency disorder).

  • Therapeutic recommendations: This may include the frequency and duration of speech therapy recommended to address the patient’s fluency disorder.

Documentation should be clear, concise, thorough to ensure appropriate reimbursement from insurance for use of the 92521 CPT code. Speech therapists can consider using pre-built templates for documenting evaluations to ensure the appropriate areas of documentation are included.


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Coding and billing tips for the 92521 CPT code

To bill the 92521 CPT code , SLPs can follow these steps:
  • Document the evaluation. Documentation should be clear and concise, and should support the use of the code by including procedures and results describing the patient’s fluency.

  • Assign the appropriate CPT code. Use the 92521 CPT code to refer to the speech fluency evaluation that was completed.

  • Submit the claim. The claim, with supporting documentation attached, should then be submitted to the appropriate payer. Automated coding and claims submission can help ensure this process is completed accurately.

It’s important to keep these common billing practices and tips in mind for accurate submission:
  • Bill for each service provided. If other services such as a language evaluation or speech sound evaluation is completed in conjunction with the fluency evaluation, ensure that each service is billed correctly.

  • Ensure the appropriate modifier is used. Be sure to use the CPT code for a fluency evaluation, not therapy.

  • Verify specific insurance requirements. Different payers may have specific billing and reimbursement processes required for fluency evaluations. SLPs should familiarize themselves with these requirements.

Reimbursement considerations

It is essential to accurately bill CPT Code 92521 to ensure proper reimbursement.

Common issues that may affect reimbursement include:
  • Insufficient documentation. Documentation that does not clearly specify the severity or type of fluency disorders may result in a claim denial.

  • Incorrect use of codes. Ensure that the CPT Code 92521 is used for speech fluency evaluations, and not other types of speech or language evaluations.

Best practices for using the 92521 CPT code

When using CPT 92521, SLPs should be sure to document the following:
  • The specific fluency disorder (ex:, stuttering, cluttering).

  • Objective assessments used to support the diagnosis. For example, standardized tests or rating scales.

  • A comprehensive history. This should include the onset of the fluency difficulties, the duration, any progression in symptoms, or specific difficult speaking environments.

It is also important to avoid common mistakes. One of these is overcoding. Only services that were actually provided should be billed for. SLPs should also avoid missing or insufficient documentation.


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Resources and tools

ICD-10 and CPT Code Lookup tools

Several tools are available to help therapists verify codes and ensure that their billing practices are up to date.

Resources include:

The 92521 CPT code should be used by speech-language pathologists when evaluating a patient for a fluency disorder. Appropriate understanding and use of this code can facilitate proper documentation and reimbursement of services.

SLPs can follow best practices for documentation, billing, and coding to streamline the billing process, reduce the risk of denials, and help ensure comprehensive care.

It is essential for therapists to review and update their coding practices regularly to ensure compliance with current CPT guidelines. By engaging in ongoing education, SLPs can remain informed about updates to maintain accuracy within coding practices.

How EHR and practice management software can save you time with insurance billing for therapists

EHRs with integrated billing software and clearing houses, such as TheraPlatform, offer therapists significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching.

What are automation and batching?

  • Automation refers to setting up software to perform tasks with limited human interaction.

  • Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.

Which billing and medical claim tasks can be automated and batched through billing software?

  • Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.

  • Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!)

  • Email payment reminders: Never manually send another reminder email for payment again, or skip this altogether by enabling auto credit card charges.

  • Live claim validation: The system reviews each claim to catch any human errors before submission, saving you time and reducing rejected claims.

  • Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform's EHR.

  • Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers.

Utilizing billing software integrated with an EHR and practice management software can make storing and sharing billing and insurance easy and save providers time when it comes to insurance billing for therapists.

TheraPlatform is an all-in-one EHR, practice management, and teletherapy software built for therapists to help them save time on admin tasks. It offers a 30-day risk-free trial with no credit card required and supports different industries and sizes of practices, including speech-language pathologists in group and solo practices.


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More resources


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References

Brundage, S. B., Ratner, N. B., Boyle, M. P., Eggers, K., Everard, R., Franken, M. C., ... & Yaruss, J. S. (2021). Consensus guidelines for the assessments of individuals who stutter across the lifespan. American journal of speech-language pathology, 30(6), 2379-2393. https://doi.org/10.1044/2021_AJSLP-21-00107

Icht, M., Zukerman, G., Zigdon, A., & Korn, L. (2023). There is more to cluttering than meets the eye: The prevalence of cluttering and association with psychological well‐being indices in an undergraduate sample. International Journal of Language & Communication Disorders, 58(6), 2022-2032. DOI: https://doi.org/10.1111/1460-6984.12917

Sugathan, N., & Maruthy, S. (2021). Predictive factors for persistence and recovery of stuttering in children: A systematic review. International Journal of Speech-Language Pathology, 23(4), 359-371. DOI: https://doi.org/10.1080/17549507.2020.1812718

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