92507 Is Ending: How to Bill Speech and Feeding Together with 92526 in 2027

You spend part of a session working on speech and another part treating a feeding problem. And when you finish, you want to know what actually goes on the claim. Can you report both services? Does one payment include everything? And with 92507 changing, what is that going to look like in 2027? That's the conversation I want to have today because check with your insurance company is a whole lot more useful when you know exactly what you're actually asking them to check. Welcome to the Untethered Podcast. I am your host, Hallie Bulkin.

I'm a certified myofunctional therapist, feeding specialist, Podcaster, business owner, and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up-to-date information in the orofacial myofunctional therapy, airway, tethered oral tissue, and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest posture. Tongue up.

Lips closed, teeth apart, breathe through your nose.

Let's get started.

Hey friends, welcome back to the Untethered Podcast. I'm Hallie Bulkin. Let's work through this with a few examples so you can picture your own sessions and like see where you may need to update your billing. Now, first of all, 92507 is scheduled to leave the CPT code set on January 1st, 2027, as many of us have heard, and its replacement is 10 separate codes, 5 treatment categories, each with A code for the initial 30 minutes and a matching code for additional 15-minute periods. The categories, those 5 categories are fluency, speech sounds, language, combined speech and language, and voice upper airway dysfunction or resonance. Okay. And until the transition, you're going to use the current codes that you have for current dates of service. So nothing's changing in 2026 as of right now. And before we talk about getting paid, final payment rates are not established yet as of September 2026. You know, when I'm recording this, proposed Medicare amounts have been published, but those are not final rates and they don't tell you what every commercial insurer or Medicaid plan will pay. So we can talk about how to report the work now, but we cannot promise what that work will reimburse in 2027. So let's just be really forward about that. Okay. What I want us to understand is that there is an opportunity that exists without making a financial decision based on a number that isn't our actual contracted rate. And you'll hear people call this bundling codes. And what we mean in this conversation is reporting more than one service on the same day. Okay, in insurance language, bundled usually means the payment for one service includes another. We're looking at when services can be reported separately though, because we want the claim to reflect the care that was actually provided. So let's start with the combination that many of you care about here, speech and feeding. And by the way, even if you are not an SLP, this is still helpful for you to know as an OT or a PT, especially if you are in a supervisory role or you own a practice, you run a clinic, whatever the case may be, you need to know about these changes. Even if you're not directly involved in billing, it is still helpful for you to know, especially if you're someone who does bill 92526, even though that's not changing. Okay, so right now 92507 describes individual speech-language treatment and 92526 describes treatment of swallowing dysfunction, you know, oral function for feeding. Okay, these are obviously different services. We are used to those. ASHA's current Medicare edit table doesn't list 92507 and 92526 as a restricted pair currently. Okay. So that means this pair doesn't automatically require a modifier like modifier 59, for example, under those edits. And listen, different insurance companies have different modifiers if they, and sometimes they do require them even though Medicare doesn't. So, so much fun. You still need your services to be appropriate, documented, and covered under a patient's plan, you know, so a commercial payer.

Mm-hmm.

They may have their own policy and you need to know what those are. So if you're already providing both, this is worth reviewing now. You don't necessarily have to wait until January to find out whether your billing is capturing the distinct services that you're delivering. Okay. Now for myofunctional therapists, I want you to think about the purpose of the work you're doing. If you're treating swallowing or oral function for feeding, 92526 may describe that service. If you're separately treating speech production, that's a different treatment purpose. Okay. So like, quote unquote, we worked on the tongue doesn't give your biller enough information to tell which service you provided. Explain the function, explain the intervention, and explain the goal. Okay, now let's move that speech and feeding session into 2027. For these examples, I want you to assume the payer adopts the new CPT codes and they use the standard CPT midpoint timing rule and permits the same-day combination. So the final 2027 edits, they still need to be checked. These examples show how the structure works. They're not a guarantee that every payer will approve the claim. Keep that in mind. Now, under the midpoint rule, 16 through 37 minutes supports the base code. At 38 minutes into a session, the first add-on becomes reportable. At 53 minutes, a second add-on unit becomes reportable. Those minutes must belong to that service. So imagine 45 minutes with a child. Okay, you've got 25 minutes of speech sound treatment, 20 minutes of separate medically necessary feeding treatment. The potential combination is 1 unit of 92656, new code for speech sounds, and 1 unit of 92526 for feeding. Okay, the speech service has enough time to meet the base threshold under the midpoint rule, and the 20 Feeding minutes then belong to feeding. We don't count them again to make the speech portion look like a 45-minute service, right? We— it's a really important thing to be aware of. The appointment may be one block on your calendar, but that doesn't mean that every minute in that block belongs to the same code, okay? We're not like double dipping across codes here. They're separating them out. That's what time-based means. Now, 92526 technically is untimed and generally reported once a day— once in a given day, I should say. You don't add another unit because you spent longer on feeding. Okay? The new speech codes work differently. Additional qualifying time is reported with the matching add-on. So for example, 45 minutes of speech sound treatment plus 15 minutes of distinct feeding treatment could support 92656 for speech, 1 unit of its add-on 92657, and 1 unit of 92526. If all the requirements are met, that's 60 minutes of actual care divided between the services with like no overlapping time. Okay, so notice what changes between those examples. It's the time spent providing each service. We haven't found a special way to call the same activity 3 things. I want— just want that to be very clear. And yes, I want clinicians to receive the payment they're entitled to. So if the plan allows separate payment for separate care, your documentation and claim should capture that, right? We also need to know when an additional code. won't be appropriate because more codes on a claim does not automatically mean like a better claim, right? And speech and language together are a good example. So if you treated articulation and language during the same visit, you're going to use the combined category. Remember, there's 5 categories and one of them is speech and language together. So in a 45-minute combined session, the potential reporting 92660 plus 1 unit of 92661 You do not report the speech-only plus language-only codes or add either one to a combined code. You're going to use the first code that I mentioned. That's why I'm not saying the separate codes because it's getting to be a lot and I don't want to confuse you, right? But within that combined service, you don't need 16 minutes of speech and another 16 minutes of language. Both areas must be meaningfully treated and documented, but the timing applies to the combined service of the 2. And that should make sense when you picture a real pediatric session. Because you may be working on speech production while also addressing language goals within that interaction, and the combined code is there to describe that work, right? Which we're— a lot of us are so used to from the old 92507 code, the one we're still using right now that's going away, right? You don't have to pretend it was 2 separate appointments with this new code. Now compare that with speech sounds and voice, that this is where it changes and gets really different. 20 minutes of distinct speech sound treatment and 20 minutes of distinct voice treatment can each meet the base threshold. The potential pair is 92656 for the speech and 92662, okay, for voice, subject to final edits and payer rules, obviously. But that's different from the speech and language example. That combined speech language category doesn't cover voice treatment any longer, okay? Each separately reported service needs its own qualifying time and clinical support. We can probably include the code pairs or something somewhere, but just know like these changes are coming down the pike and they're published. You can see all of these, you know, new proposed codes and everything. What I want you to hear though is that there are 2 different reasons you might report more than one code: additional time in the same service or a separate service that can appropriately be reported alongside it. Okay? And the add-on belongs to its matching base code. You can't use a language add-on with a speech-only base because, hello, they have a combined version of that. And you can't report an add-on by itself because it's an add-on, right? This is making sense. Yes, we're tracking. This is where I would sit down with my biller and walk through a few actual, like, de-identified visits. Like, start with what happened clinically, work out the time for each service, and then see whether the claim matches. That conversation will tell you more than saying like, okay, which combination pays the most before you even know what you're treating. Like, hello. Let's also clear up modifier -59 because it tends to come up anytime we discuss multiple services. It used to identify a distinct service when an applicable coding edit allows that distinction to override the restriction. It isn't something you automatically add every time you submit 2 codes. Some payers use a more specific modifier depending on the payer. So fun. And some code combinations can't be overridden at all. It just depends. So for the new codes, don't assume the modifier instructions will be identical to what you're using today. Okay? When the 2027 edits become available, have your biller check the exact pair, whether a modifier is needed or even allowed, and which line it belongs on. Because a modifier doesn't turn overlapping work into like separate care or anything. Okay. There's another payment piece that I want to make understandable without taking you through an entire Medicare seminar, because I'm not the Medicare expert. I've just been doing a lot of reading and understanding of all these changes coming because people are freaking out online when there's no reason. Let's all take a deep breath. Okay. Even when 2 services can be reported, that doesn't always mean 2 full payments. Medicare's proposed multiple procedure payment reduction can reduce the practice expense portion of an additional eligible same-day service. The new speech add-ons would be excluded from that reduction. So if you're estimating what a speech plus feeding visit might pay, you need the payer's rules for that combination as well as the individual rates. We cannot calculate the final increase in payment just by counting the number of codes. For pediatric clinicians, CMS has also proposed a separate code called GSLPP. It's not final. We don't yet have a settled answer about its implementation or interaction with other services, so don't substitute it into these examples or assume every pediatric payer will require it. But that's where our uncertainty, like, rightly belongs, if you will. Like, we can understand the new CPT structure while still being honest about the pieces that just haven't been finalized and that are still up in the air. And if you're private pay, like my practice, this still matters when you provide super bills. You still need this information, okay? The families that you're giving super bills to are using your documentation to request reimbursement. And so we wanted to show what they actually received with the appropriate codes for the date of service that they received services, right? We can't promise what their insurance will pay, but we can make sure that we are not handing them inaccurate paperwork. So this also falls on you to understand this. Now let's talk about why feeding belongs in this discussion beyond the claim itself. Okay. A child can come to your practice for speech and also have a feeding need, right? And if nobody asks about eating, you know, or mealtimes or whatever, like you may never identify it. If you do identify it, the next step might be a feeding evaluation with someone on your team or a referral to another provider, but screening helps us determine that next step. Okay. And again, just remember screening never replaces assessment. Little, little side note there. I do want more clinicians prepared to recognize those concerns and more practices prepared to provide the care when appropriate. And it makes sense to look at whether you're repeatedly sending families elsewhere for a service that maybe your team could develop the skills to offer. Hello? Ding, ding, ding. Little light bulb moment for anybody? The reason to build that skill is the patient need. Okay? Understanding the coding helps you plan how to deliver the service sustainably, but those 2 conversations belong together. We don't need to be uncomfortable talking about payment when payment is part of keeping care available and super important. Right now, if you're the employer, I want you to look at feeding referrals that you receive into your, you know, into your practice group, into your business, into the clinic, wherever you are. Look at the feeding referrals you're receiving and what happens to those families. If there's a need that you cannot currently meet, investing in an employee's training and mentorship may be a practical way to expand your services. Give them the support to develop the competence that they need before expecting them to take on a feeding caseload, please and thank you. Now, if you're the employee, bringing that need to your supervisor with a specific proposal You could say something like, hey, I'd like to develop my feeding skills so we can explore offering this care here. Could we look at covering the training and planning how I'd apply it with support? Okay, now bring the course cost and the time commitment and ask whether the practice can pay directly or reimburse you. That would be my approach. Definitely, you know, if you need to, you can get approval before enrolling, including what the employer will cover and what they need from you. But a course like Feed the Peeds, for example, can be part of that conversation. But the request should explain what you're hoping to bring back to your place of work, to the practice, to your clinic, right? To the patients, to their financial bottom line, which is going to drive so much more when it comes to businesses, right? Everything's a business. Everything is sales. We got to really explain to them why we want them to make this investment in us. Now, before you change anything on a claim, I want you to take a few representative sessions to your biller and ask them to confirm the code combinations. and payment policies with your payers. And if feeding is a skill you'd like to develop, I want to help you start with recognizing when a child needs a closer look. So join me for Screen the Peeds to Feed the Peeds, which is my free 3-day training, September 28th through 30th at noon Eastern time. We're going to use my pediatric feeding screening packet to work through recognizing feeding red flags and understanding the next step. You can register at feedthepeeds.com/training. And I would love for you to bring a colleague or 10 or invite your supervisor if this is a service you're thinking about building together. And I'd love for this episode to start a really useful conversation, both about the care that your families need and how your practice can support providing it, especially with all of the billing changes coming down the pike. Because hello, 92526 is not currently changing and is something that practices can still bill and/or put on their super bills if you're private pay. So we should all be paying attention to this. As 92507, you know, is currently under scrutiny and a lot of things are changing, but hey, maybe it's for the better. I guess we'll find out soon. All right, everybody. I will see you next time on the Untethered Podcast. I look forward to seeing you all at feedthepeds.com/training for the free 3-day training. You will get 4 hours on a certificate of completion for free. There are other opportunities to become a VIP as well. So check that out on the page and I look forward to seeing you all there. Talk to you soon.

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All information, content, and material of this podcast are the opinions of the speakers and serves as the informational purposes only and not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified healthcare provider.

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