CPT code 92521: Speech evaluation, fluency2026 Medicare rate & RVUs in New Jersey
A speech-language pathologist evaluates fluency problems such as stuttering or cluttering to characterize communication difficulties and guide care.
Medicare pays $141.64–$147.30 for 92521 in the office in New Jersey, from Rest of New Jersey to Northern New Jersey. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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.
Where 92521 pays more and less in New Jersey
| Payment locality | Office | Facility |
|---|---|---|
| Northern New Jersey | $147.30 | Unavailable |
| Rest of New Jersey | $141.64 | Unavailable |
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.
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.
92521 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 92522Speech evaluationSpeech sound production
- Choose 92521 for a fluency assessment, such as evaluation of stuttering. Choose 92522 when the assessment centers on speech sound production.
- 92523Speech-language evaluationSpeech plus language assessment
- 92523 covers speech sound production together with language comprehension and expression; 92521 focuses on fluency.
- 92524Voice evaluationBehavioral and perceptual analysis
- 92524 assesses voice quality and related vocal characteristics. 92521 is for evaluation of speech fluency.
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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