Speech Therapy Billing Codes: 2027 Treatment Code Changes and SLP and OT Evaluation CPT Codes

Accurate CPT codes are essential for documenting evaluations and treatments. For speech-language pathology, starting January 1, 2027, CPT code 92507 will be replaced by 10 time-based codes organized into five clinical categories.

According to ASHA, the five categories and their new codes are:

All 10 codes are for one-on-one treatment. An add-on code is always billed with its matching base code, never on its own. Group treatment (two or more people) stays on 92508, which remains untimed.

Why? According to ASHA, a CMS review of Medicare utilization for CPT code 92507 found that use of the code increased by more than 100% between 2017 and 2022. That increase prompted additional payer scrutiny and a reassessment of the code's structure and valuation.

Whether the setting is a school, home, or skilled nursing facility, SLPs and OTs rely on clinical reasoning to capture a patient's baseline, document the precise level of help required, and track improvement.

Clinicians are busy evaluating how the new time increments may affect daily scheduling, productivity tracking, and insurance authorization limits, as well as how private payers may authorize multiple codes during one session—or how National Correct Coding Initiative (NCCI) edits may affect billing for overlapping treatment categories.

Which CPT Code Does a Speech Therapy Evaluation Use, and What Must the Note Show?

The speech therapy evaluation CPT code is one of four untimed codes, billed as one unit no matter how long the evaluation takes: 92521 for fluency, 92522 for speech sound production, 92523 for speech sound production plus language, and 92524 for voice and resonance. The note must show the clinical findings for that area, a diagnosis, and treatment recommendations.

These codes aren't changing in 2027. A few SLP evaluations are timed: the aphasia assessment (96105) is billed per hour, and AAC device evaluations (92605 and 92607) are billed by the first hour, with add-on codes for each additional 30 minutes. For the treatment code change, see ASHA's guide to the new codes replacing 92507.

Speech therapy billing codes tell the payer what service was provided, but payers decide on funding for specialized services and equipment based largely on two documents: the evaluation report and the physician's order. The evaluation report has to show the clinical findings that justify the service or device. The physician's order has to state that the service or device is medically necessary and list the diagnosis codes it is based on. Those diagnosis codes should match the diagnosis in the evaluation report. If either document is missing that information, or the two don't agree, authorization can be delayed or denied.

This matters most for augmentative and alternative communication (AAC) devices. The evaluation should connect the patient's communication deficits to the specific device being recommended and explain why it is medically necessary. The physician's order should then state that necessity and list the same diagnosis codes.

Occupational Therapy Evaluation CPT Codes by Complexity Level

The occupational therapy evaluation CPT code is 97165 (low), 97166 (moderate), or 97167 (high complexity). These codes aren't changing in 2027. The level depends on three components: the occupational profile and history, the performance deficits found, and clinical decision-making.

Per AOTA guidelines, the lowest-scoring component sets the level. If two components qualify as high complexity but one falls into low complexity, the entire evaluation is billed at the low-complexity level.

Timed and Untimed Codes, Minutes, and Documentation

CMS splits therapy codes into two types:

• Untimed codes: Billed once per session regardless of duration.
• Timed codes: Vary based on direct, one-on-one treatment minutes.

The CMS 8-minute rule dictates that speech and occupational therapists must provide at least 8 minutes of direct, one-on-one treatment to bill for a single 15-minute unit under Medicare Part B. Total timed minutes per day are aggregated and divided by 15; a remainder of 8 minutes or more counts as an extra billable unit.

Other payers may use different methodologies, and code-specific instructions may apply. Routine preparation and documentation time generally do not count as direct treatment time. See ASHA's guide to timed and untimed CPT codes for additional guidance.

CMS 8-Minute Unit Conversion Chart

How Time Works for the New Speech Treatment Codes

Starting January 1, 2027, speech treatment is billed with timed codes for the first time. These codes follow a different structure from the chart above. Each base code covers the first 30 minutes. Under the general CPT midpoint convention, ASHA lists 16–37 minutes for one base code. For example, 48 minutes falls in the 38–52 minute range and supports a base code plus one add-on unit. A 55-minute session falls in the 53–67 minute range and supports a base code plus two.

These are CPT conventions, not Medicare's final word. NCCI and Medically Unlikely Edit requirements are expected in the last quarter of 2026. ASHA notes that CMS rules and payer policies may set different requirements, so check each payer's policy before billing.

Defensible Documentation: Clinical Sentence Structures

Effective documentation must reflect the individual patient's presentation, the skilled service provided, the response to treatment, and progress toward measurable goals. Generic or copied language that does not accurately describe the encounter can jeopardize the record. The following sentence structures are ideas, not substitutes for individualized clinical documentation.

Skilled need:

Medical necessity:

Progress toward goals:

Whenever possible, describe the type and level of cueing or assistance provided, the patient's response, and objective changes from baseline. Include only details supported by the actual clinical encounter.

If you write any of these sentences several times a day, you can save the wording as your own shortcut in Text Blaze, with fill-in boxes for the details that change, such as the impairment, the intervention, or the goal. You type the shortcut in your note, fill in what's true for this patient today, and the rest of the sentence is already there.

Using Templates Without Losing Individualized Detail

Reusable language should save typing without turning every session into the same note.

Text Blaze keeps that repeated wording one shortcut away, and it has a free plan. You type a short shortcut in the field you already chart in, a small form asks for the details that change, and the finished text appears in your own words. The structure takes seconds, so your time goes to what you observed in today's session.

The Medical Necessity, Prior Authorization & Appeal Letter Templates for SLPs and OTs cover the paperwork that comes before and after treatment. The pack includes a medical necessity letter (/lmn), a prior authorization request (/par), an appeal letter (/appeal), and a plan of care summary (/pocsum).

For session documentation, the Speech Therapy SOAP & Session Note Templates include a full SOAP note along with skilled service, progress, and plan lines. The OT SOAP Note, Daily Note & Skilled Documentation Phrases include an OT SOAP note, skilled-service phrases, ADL lines, and a SNF daily note. Each pack can be added to your Text Blaze account in one click, and every snippet can be edited to match your own wording.

This is not an AI note-writing tool. Text Blaze inserts wording you have saved and leaves the patient-specific findings to you.

Text Blaze works on computers through Chrome and Edge and through Windows and Mac apps. It can insert saved wording in browser-based EHRs, fax portals and email.

Install the free medical necessity letter pack.