CPT code 92521: Speech evaluation, fluency2026 Medicare rate & RVUs in Iowa
A speech-language pathologist evaluates fluency problems such as stuttering or cluttering to characterize communication difficulties and guide care.
In Iowa, Medicare pays $128.13 for 92521 in the office.
Check a contract rate as a % of Medicare · 92521 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 92521 covers
A speech-language pathologist uses this service to assess fluency problems, including stuttering or cluttering. The evaluation may include conversation and structured speaking tasks, with attention to disruptions such as repetitions, prolongations, or blocks and how they affect communication. It is distinct from assessment focused on speech sound production, language, or voice. These evaluations are commonly performed in outpatient speech-language pathology settings.
Report the service when the evaluation centers on fluency rather than another speech or language domain. Documentation should describe the assessment methods, observed fluency behaviors, their impact on communication, and clinical conclusions or recommendations. CMS treats this as a therapy service, not as separate professional and technical portions, so a professional-component modifier is not used. When multiple therapy services are billed on the same day, CMS reduces practice-expense payment for the second and later therapy units under the therapy multiple-procedure payment rule.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
How Iowa compares for 92521
Across 109 of 109 payment localities, the office rate for 92521 runs from $124.91 in Arkansas to $174.31 in Alaska. Iowa pays $128.13. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Iowa · this page$128.13
- Los Angeles, CA · California$146.86+$18.73
- Washington, DC area · District of Columbia$147.69+$19.56
- Miami, FL · Florida$136.16+$8.03
- Chicago, IL · Illinois$134.52+$6.39
- Manhattan, NY · New York$147.67+$19.54
- Alaska · Alaska$174.31+$46.18
Other areas in Iowa first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $125.86 | — |
| ArkansasArkansas | $124.91 | — |
| ArizonaArizona | $131.42 | — |
| Bakersfield, CACalifornia | $140.14 | — |
| Chico, CACalifornia | $139.97 | — |
| El Centro, CACalifornia | $139.97 | — |
| Fresno, CACalifornia | $139.97 | — |
| Hanford, CACalifornia | $139.97 | — |
| Madera, CACalifornia | $139.97 | — |
| Merced, CACalifornia | $139.97 | — |
| Modesto, CACalifornia | $139.97 | — |
| Napa, CACalifornia | $156.30 | — |
| Oxnard, CACalifornia | $145.82 | — |
| Redding, CACalifornia | $139.97 | — |
| Rest of CaliforniaCalifornia | $139.97 | — |
| Riverside, CACalifornia | $140.15 | — |
| Sacramento, CACalifornia | $145.28 | — |
| Salinas, CACalifornia | $144.67 | — |
| San Diego, CACalifornia | $146.75 | — |
| Marin County, CACalifornia | $164.02 | — |
| San Francisco, CACalifornia | $164.01 | — |
| San Benito County, CACalifornia | $167.03 | — |
| Santa Clara County, CACalifornia | $166.99 | — |
| San Luis Obispo, CACalifornia | $142.46 | — |
| Santa Cruz, CACalifornia | $147.18 | — |
| Santa Maria, CACalifornia | $144.86 | — |
| Santa Rosa, CACalifornia | $148.61 | — |
| Stockton, CACalifornia | $139.97 | — |
| Vallejo, CACalifornia | $156.28 | — |
| Visalia, CACalifornia | $139.97 | — |
| Yuba City, CACalifornia | $139.97 | — |
| ColoradoColorado | $137.81 | — |
| ConnecticutConnecticut | $139.31 | — |
| DelawareDelaware | $132.91 | — |
| Fort Lauderdale, FLFlorida | $134.29 | — |
| Rest of FloridaFlorida | $130.88 | — |
| Atlanta, GAGeorgia | $134.49 | — |
| Rest of GeorgiaGeorgia | $127.06 | — |
| Hawaii, Guam, HIHawaii | $141.09 | — |
| IdahoIdaho | $128.44 | — |
| East St. Louis, ILIllinois | $128.96 | — |
| Rest of IllinoisIllinois | $128.40 | — |
| Suburban Chicago, ILIllinois | $135.62 | — |
| IndianaIndiana | $128.86 | — |
| KansasKansas | $127.52 | — |
| KentuckyKentucky | $126.79 | — |
| New Orleans, LALouisiana | $129.89 | — |
| Rest of LouisianaLouisiana | $126.57 | — |
| Metropolitan Boston, MAMassachusetts | $147.58 | — |
| Rest of MassachusettsMassachusetts | $137.48 | — |
| Baltimore area, MDMaryland | $138.79 | — |
| Rest of MarylandMaryland | $134.69 | — |
| Rest of MaineMaine | $128.49 | — |
| Southern Maine, MEMaine | $132.62 | — |
| Detroit, MIMichigan | $131.46 | — |
| Rest of MichiganMichigan | $128.26 | — |
| MinnesotaMinnesota | $134.72 | — |
| Metropolitan Kansas City, MOMissouri | $129.72 | — |
| Metropolitan St. Louis, MOMissouri | $130.48 | — |
| Rest of MissouriMissouri | $125.24 | — |
| MississippiMississippi | $125.10 | — |
| MontanaMontana | $133.27 | — |
| North CarolinaNorth Carolina | $129.26 | — |
| North DakotaNorth Dakota | $133.07 | — |
| NebraskaNebraska | $128.59 | — |
| New HampshireNew Hampshire | $135.61 | — |
| Northern New JerseyNew Jersey | $147.30 | — |
| Rest of New JerseyNew Jersey | $141.64 | — |
| New MexicoNew Mexico | $128.51 | — |
| NevadaNevada | $133.27 | — |
| NYC suburbs and Long Island, NYNew York | $149.33 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $142.23 | — |
| Queens, NYNew York | $148.78 | — |
| Rest of New YorkNew York | $130.26 | — |
| OhioOhio | $128.22 | — |
| OklahomaOklahoma | $126.98 | — |
| Portland, OROregon | $140.83 | — |
| Rest of OregonOregon | $132.94 | — |
| Metropolitan Philadelphia, PAPennsylvania | $137.06 | — |
| Rest of PennsylvaniaPennsylvania | $128.49 | — |
| Puerto RicoPuerto Rico | $133.90 | — |
| Rhode IslandRhode Island | $136.57 | — |
| South CarolinaSouth Carolina | $128.80 | — |
| South DakotaSouth Dakota | $133.05 | — |
| TennesseeTennessee | $127.83 | — |
| Austin, TXTexas | $136.75 | — |
| Beaumont, TXTexas | $128.02 | — |
| Brazoria, TXTexas | $133.27 | — |
| Dallas, TXTexas | $133.66 | — |
| Fort Worth, TXTexas | $133.09 | — |
| Galveston, TXTexas | $133.40 | — |
| Houston, TXTexas | $133.59 | — |
| Rest of TexasTexas | $130.27 | — |
| UtahUtah | $129.75 | — |
| VirginiaVirginia | $132.18 | — |
| Virgin Islands, VIUnited States Virgin Islands | $133.90 | — |
| VermontVermont | $132.52 | — |
| Rest of WashingtonWashington | $137.24 | — |
| King County, WAWashington | $150.14 | — |
| WisconsinWisconsin | $130.60 | — |
| West VirginiaWest Virginia | $125.80 | — |
| WyomingWyoming | $133.18 | — |
92521 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$124.91
$174.31
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $174.31 | 1 |
| AL | $125.86 | 1 |
| AR | $124.91 | 1 |
| AZ | $131.42 | 1 |
| CA | $139.97–$167.03 | 29 |
| CO | $137.81 | 1 |
| CT | $139.31 | 1 |
| DC | $147.69 | 1 |
| DE | $132.91 | 1 |
| FL | $130.88–$136.16 | 3 |
| GA | $127.06–$134.49 | 2 |
| GU | $141.09 | 1 |
| HI | $141.09 | 1 |
| IA | $128.13 | 1 |
| ID | $128.44 | 1 |
| IL | $128.40–$135.62 | 4 |
| IN | $128.86 | 1 |
| KS | $127.52 | 1 |
| KY | $126.79 | 1 |
| LA | $126.57–$129.89 | 2 |
| MA | $137.48–$147.58 | 2 |
| MD | $134.69–$147.69 | 3 |
| ME | $128.49–$132.62 | 2 |
| MI | $128.26–$131.46 | 2 |
| MN | $134.72 | 1 |
| MO | $125.24–$130.48 | 3 |
| MS | $125.10 | 1 |
| MT | $133.27 | 1 |
| NC | $129.26 | 1 |
| ND | $133.07 | 1 |
| NE | $128.59 | 1 |
| NH | $135.61 | 1 |
| NJ | $141.64–$147.30 | 2 |
| NM | $128.51 | 1 |
| NV | $133.27 | 1 |
| NY | $130.26–$149.33 | 5 |
| OH | $128.22 | 1 |
| OK | $126.98 | 1 |
| OR | $132.94–$140.83 | 2 |
| PA | $128.49–$137.06 | 2 |
| PR | $133.90 | 1 |
| RI | $136.57 | 1 |
| SC | $128.80 | 1 |
| SD | $133.05 | 1 |
| TN | $127.83 | 1 |
| TX | $128.02–$136.75 | 8 |
| UT | $129.75 | 1 |
| VA | $132.18–$147.69 | 2 |
| VI | $133.90 | 1 |
| VT | $132.52 | 1 |
| WA | $137.24–$150.14 | 2 |
| WI | $130.60 | 1 |
| WV | $125.80 | 1 |
| WY | $133.18 | 1 |
How the 92521 rate is calculated
Each of 92521’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 92521
RVUs × geographic indexes × conversion factor
Work2.24
2.24 RVUs× 1.000 GPCI
Practice expense1.74
1.74 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
3.9900
Conversion factor
$33.4009
Medicare rate
$133.27
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Iowa inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
11,788
- Code
- 92521
- Physician work
- 2.24
- Practice expense
- 1.74
- Malpractice
- 0.01
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.24 | × 1.000 | 2.2400 |
| Practice expense | 1.74 | × 0.915 | 1.5921 |
| Malpractice | 0.01 | × 0.397 | 0.0040 |
| Total RVUs | 3.8361 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Iowa$128.13
Office: (2.24 × 1 + 1.74 × 0.915 + 0.01 × 0.397) × $33.4009 = $128.13
Payment rules and modifiers for 92521
The CMS indicators that decide how 92521 is paid alongside other services.
CMS payment indicators · 92521
Speech evaluation, fluency
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 5 | Therapy reduction: practice expense of the second and later units is reduced. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 7 | Therapy service: the split doesn’t apply. |
What modifiers do to the payment
Modifier CQ · payment effect
With and without the modifier
92521 without CQ · national office
$133.27
Speech evaluation, fluency
92521-CQ · Allowed amount unchanged
$133.27
Medicare cuts its own payment by 15% after the patient’s 20% coinsurance; the allowed amount stays the same. On $100 allowed: $20 coinsurance, then Medicare pays $68 instead of $80.
How 92521 has changed in Iowa
92521 · Office / nonfacility
$128.13
Effective 2026-10-01
The base rate is $3.25 higher than on 2025-10-01, moving from $124.88 to $128.13 (2.6%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$124.88changed to$128.13
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 1.75 changed to 1.74
- Malpractice RVU 0.05 changed to 0.01
- Practice expense GPCI 0.913 changed to 0.915
- Malpractice GPCI 0.457 changed to 0.397
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$126.84changed to$124.88
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 1.69 changed to 1.75
- Malpractice RVU 0.06 changed to 0.05
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$124.77changed to$126.84
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$127.99changed to$124.77
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 1.66 changed to 1.69
- Practice expense GPCI 0.910 changed to 0.913
- Malpractice GPCI 0.441 changed to 0.457
January 1, 2023
RVU23A
$128.75changed to$127.99
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 1.59 changed to 1.66
- Malpractice RVU 0.09 changed to 0.06
- Practice expense GPCI 0.907 changed to 0.910
- Malpractice GPCI 0.425 changed to 0.441
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$129.82changed to$128.75
- Conversion factor 34.8931 changed to 34.6062
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$109.55changed to$129.82
- Conversion factor 36.0896 changed to 34.8931
- Work RVU 1.75 changed to 2.24
- Practice expense RVU 1.38 changed to 1.59
- Malpractice RVU 0.08 changed to 0.09
- Malpractice GPCI 0.424 changed to 0.425
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$109.75changed to$109.55
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.40 changed to 1.38
- Malpractice RVU 0.06 changed to 0.08
- Malpractice GPCI 0.423 changed to 0.424
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$110.10changed to$109.75
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.41 changed to 1.40
- Malpractice RVU 0.07 changed to 0.06
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$106.53changed to$110.10
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.31 changed to 1.41
- Malpractice RVU 0.08 changed to 0.07
- Practice expense GPCI 0.902 changed to 0.907
- Malpractice GPCI 0.458 changed to 0.423
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$105.77changed to$106.53
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 1.30 changed to 1.31
- Practice expense GPCI 0.896 changed to 0.902
- Malpractice GPCI 0.493 changed to 0.458
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$103.40changed to$105.77
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 1.22 changed to 1.30
- Malpractice RVU 0.07 changed to 0.08
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$102.89changed to$103.40
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$108.11changed to$102.89
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 1.40 changed to 1.22
- Malpractice RVU 0.04 changed to 0.07
- Practice expense GPCI 0.892 changed to 0.896
- Malpractice GPCI 0.475 changed to 0.493
Held through RVU15B.
January 1, 2014
RVU14A
No ratechanged to$108.11
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $128.13 | Not available in this setting | RVU26D |
| 2026-07-01 | $128.13 | Not available in this setting | RVU26C |
| 2026-04-01 | $128.13 | Not available in this setting | RVU26B |
| 2026-01-01 | $128.13 | Not available in this setting | RVU26A |
| 2025-10-01 | $124.88 | Not available in this setting | RVU25D |
| 2025-07-01 | $124.88 | Not available in this setting | RVU25C |
| 2025-04-01 | $124.88 | Not available in this setting | RVU25B |
| 2025-01-01 | $124.88 | Not available in this setting | RVU25A |
| 2024-10-01 | $126.84 | Not available in this setting | RVU24D |
| 2024-07-01 | $126.84 | Not available in this setting | RVU24C |
| 2024-04-01 | $126.84 | Not available in this setting | RVU24B |
| 2024-03-09 | $126.84 | Not available in this setting | RVU24AR |
| 2024-01-01 | $124.77 | Not available in this setting | RVU24A |
| 2023-10-01 | $127.99 | Not available in this setting | RVU23D |
| 2023-07-01 | $127.99 | Not available in this setting | RVU23C |
| 2023-04-01 | $127.99 | Not available in this setting | RVU23B |
| 2023-01-01 | $127.99 | Not available in this setting | RVU23A |
| 2022-10-01 | $128.75 | Not available in this setting | RVU22D |
| 2022-07-01 | $128.75 | Not available in this setting | RVU22C |
| 2022-04-01 | $128.75 | Not available in this setting | RVU22B |
| 2022-01-01 | $128.75 | Not available in this setting | RVU22A |
| 2021-10-01 | $129.82 | Not available in this setting | RVU21D |
| 2021-07-01 | $129.82 | Not available in this setting | RVU21C |
| 2021-04-01 | $129.82 | Not available in this setting | RVU21B |
| 2021-01-01 | $129.82 | Not available in this setting | RVU21A |
| 2020-10-01 | $109.55 | Not available in this setting | RVU20D |
| 2020-07-01 | $109.55 | Not available in this setting | RVU20C |
| 2020-04-01 | $109.55 | Not available in this setting | RVU20B |
| 2020-01-01 | $109.55 | Not available in this setting | RVU20A |
| 2019-10-01 | $109.75 | Not available in this setting | RVU19D |
| 2019-07-01 | $109.75 | Not available in this setting | RVU19C |
| 2019-04-01 | $109.75 | Not available in this setting | RVU19B |
| 2019-01-01 | $109.75 | Not available in this setting | RVU19A |
| 2018-10-01 | $110.10 | Not available in this setting | RVU18D |
| 2018-07-01 | $110.10 | Not available in this setting | RVU18C |
| 2018-04-01 | $110.10 | Not available in this setting | RVU18B |
| 2018-01-01 | $110.10 | Not available in this setting | RVU18AR1 |
| 2017-10-01 | $106.53 | Not available in this setting | RVU17D |
| 2017-07-01 | $106.53 | Not available in this setting | RVU17C |
| 2017-04-01 | $106.53 | Not available in this setting | RVU17B |
| 2017-01-01 | $106.53 | Not available in this setting | RVU17A |
| 2016-10-01 | $105.77 | Not available in this setting | RVU16D |
| 2016-07-01 | $105.77 | Not available in this setting | RVU16C |
| 2016-04-01 | $105.77 | Not available in this setting | RVU16B |
| 2016-01-01 | $105.77 | Not available in this setting | RVU16A |
| 2015-10-01 | $103.40 | Not available in this setting | RVU15D |
| 2015-07-01 | $103.40 | Not available in this setting | RVU15C |
| 2015-04-01 | $102.89 | Not available in this setting | RVU15B |
| 2015-01-01 | $102.89 | Not available in this setting | RVU15A |
| 2014-10-01 | $108.11 | Not available in this setting | RVU14D |
| 2014-07-01 | $108.11 | Not available in this setting | RVU14C |
| 2014-04-01 | $108.11 | Not available in this setting | RVU14B |
| 2014-01-01 | $108.11 | Not available in this setting | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Iowa rate applies
Iowa is a Medicare payment area, not a city. Our Census mapping connects it to 1026 cities and communities in Iowa. Some span more than one payment area; confirm with the service ZIP.
- Ackley
- Ackworth
- Adair
- Adel
- Afton
- Agency
- Ainsworth
- Akron
92521 billing questions
When should 92521 be chosen instead of 92522?
Use 92521 when the evaluation focuses on fluency disruptions such as stuttering or cluttering. Use 92522 when the primary focus is speech sound production.
How does 92521 differ from 92523?
92521 assesses fluency. 92523 addresses speech sound production together with language comprehension and expression.
Can 92521 be reported with a professional-component modifier?
No. CMS identifies 92521 as a therapy service without separate professional and technical components.
What documentation supports reporting 92521?
Document the fluency assessment methods, observed behaviors, communication impact, and clinical findings or recommendations. The record should show that fluency was the evaluation focus.
What happens when other therapy services are billed the same day?
CMS reduces practice-expense payment for the second and later therapy units under its therapy multiple-procedure payment rule.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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