CPT code 92609: Speech device therapy, programming and use training2026 Medicare rate & RVUs in Puerto Rico
Speech-language pathologists report this therapy for skilled training in using a speech-generating communication device, including device programming and modification.
In Puerto Rico, Medicare pays $103.11 for 92609 in the office.
Check a contract rate as a % of Medicare · 92609 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 92609 covers
A speech-language pathologist uses this service to help a person communicate with a speech-generating device, such as an augmentative and alternative communication system that produces spoken output. The work may include teaching the patient to operate the device, adapting its vocabulary or settings to support communication, and modifying programming as communication needs change. Services are typically furnished in outpatient therapy settings, including clinics and offices, and may involve caregiver instruction when it supports the patient’s device use.
Report 92609 for skilled therapeutic work with the speech-generating device, not for evaluating whether a device should be prescribed. The record should identify the device and describe the skilled training, programming, or modifications performed and their connection to the patient’s communication goals. The CMS therapy multiple procedure payment reduction decreases the practice expense portion for the second and later therapy units on the same day. The professional component modifier does not apply to this therapy service.
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 Puerto Rico compares for 92609
Across 109 of 109 payment localities, the office rate for 92609 runs from $95.03 in Arkansas to $130.93 in San Benito County, CA. Puerto Rico pays $103.11. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$103.11
- Los Angeles, CA · California$114.02+$10.91
- Washington, DC area · District of Columbia$114.56+$11.45
- Miami, FL · Florida$105.19+$2.08
- Chicago, IL · Illinois$103.58+$0.47
- Manhattan, NY · New York$114.38+$11.27
- Alaska · Alaska$130.83+$27.72
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $95.88 | — |
| ArkansasArkansas | $95.03 | — |
| ArizonaArizona | $100.88 | — |
| Bakersfield, CACalifornia | $108.36 | — |
| Chico, CACalifornia | $108.24 | — |
| El Centro, CACalifornia | $108.24 | — |
| Fresno, CACalifornia | $108.24 | — |
| Hanford, CACalifornia | $108.24 | — |
| Madera, CACalifornia | $108.24 | — |
| Merced, CACalifornia | $108.24 | — |
| Modesto, CACalifornia | $108.24 | — |
| Napa, CACalifornia | $122.10 | — |
| Oxnard, CACalifornia | $113.30 | — |
| Redding, CACalifornia | $108.24 | — |
| Rest of CaliforniaCalifornia | $108.24 | — |
| Riverside, CACalifornia | $108.40 | — |
| Sacramento, CACalifornia | $112.68 | — |
| Salinas, CACalifornia | $112.22 | — |
| San Diego, CACalifornia | $114.10 | — |
| Marin County, CACalifornia | $128.48 | — |
| San Francisco, CACalifornia | $128.47 | — |
| San Benito County, CACalifornia | $130.93 | — |
| Santa Clara County, CACalifornia | $130.88 | — |
| San Luis Obispo, CACalifornia | $110.48 | — |
| Santa Cruz, CACalifornia | $114.64 | — |
| Santa Maria, CACalifornia | $112.44 | — |
| Santa Rosa, CACalifornia | $115.77 | — |
| Stockton, CACalifornia | $108.24 | — |
| Vallejo, CACalifornia | $122.09 | — |
| Visalia, CACalifornia | $108.24 | — |
| Yuba City, CACalifornia | $108.24 | — |
| ColoradoColorado | $106.40 | — |
| ConnecticutConnecticut | $107.63 | — |
| DelawareDelaware | $102.13 | — |
| Fort Lauderdale, FLFlorida | $103.49 | — |
| Rest of FloridaFlorida | $100.42 | — |
| Atlanta, GAGeorgia | $103.59 | — |
| Rest of GeorgiaGeorgia | $96.98 | — |
| Hawaii, Guam, HIHawaii | $109.54 | — |
| IowaIowa | $97.91 | — |
| IdahoIdaho | $98.20 | — |
| East St. Louis, ILIllinois | $98.71 | — |
| Rest of IllinoisIllinois | $98.20 | — |
| Suburban Chicago, ILIllinois | $104.56 | — |
| IndianaIndiana | $98.57 | — |
| KansasKansas | $97.37 | — |
| KentuckyKentucky | $96.73 | — |
| New Orleans, LALouisiana | $99.51 | — |
| Rest of LouisianaLouisiana | $96.53 | — |
| Metropolitan Boston, MAMassachusetts | $114.67 | — |
| Rest of MassachusettsMassachusetts | $106.04 | — |
| Baltimore area, MDMaryland | $107.23 | — |
| Rest of MarylandMaryland | $103.64 | — |
| Rest of MaineMaine | $98.25 | — |
| Southern Maine, MEMaine | $101.95 | — |
| Detroit, MIMichigan | $100.95 | — |
| Rest of MichiganMichigan | $98.05 | — |
| MinnesotaMinnesota | $103.82 | — |
| Metropolitan Kansas City, MOMissouri | $99.35 | — |
| Metropolitan St. Louis, MOMissouri | $100.04 | — |
| Rest of MissouriMissouri | $95.34 | — |
| MississippiMississippi | $95.21 | — |
| MontanaMontana | $102.54 | — |
| North CarolinaNorth Carolina | $98.93 | — |
| North DakotaNorth Dakota | $102.34 | — |
| NebraskaNebraska | $98.32 | — |
| New HampshireNew Hampshire | $104.64 | — |
| Northern New JerseyNew Jersey | $114.06 | — |
| Rest of New JerseyNew Jersey | $109.37 | — |
| New MexicoNew Mexico | $98.28 | — |
| NevadaNevada | $102.54 | — |
| NYC suburbs and Long Island, NYNew York | $115.88 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $109.82 | — |
| Queens, NYNew York | $115.38 | — |
| Rest of New YorkNew York | $99.84 | — |
| OhioOhio | $98.01 | — |
| OklahomaOklahoma | $96.89 | — |
| Portland, OROregon | $109.04 | — |
| Rest of OregonOregon | $102.23 | — |
| Metropolitan Philadelphia, PAPennsylvania | $105.64 | — |
| Rest of PennsylvaniaPennsylvania | $98.25 | — |
| Rhode IslandRhode Island | $105.18 | — |
| South CarolinaSouth Carolina | $98.53 | — |
| South DakotaSouth Dakota | $102.32 | — |
| TennesseeTennessee | $97.64 | — |
| Austin, TXTexas | $105.63 | — |
| Beaumont, TXTexas | $97.83 | — |
| Brazoria, TXTexas | $102.40 | — |
| Dallas, TXTexas | $102.74 | — |
| Fort Worth, TXTexas | $102.22 | — |
| Galveston, TXTexas | $102.52 | — |
| Houston, TXTexas | $102.70 | — |
| Rest of TexasTexas | $99.85 | — |
| UtahUtah | $99.38 | — |
| VirginiaVirginia | $101.56 | — |
| Virgin Islands, VIUnited States Virgin Islands | $103.11 | — |
| VermontVermont | $101.85 | — |
| Rest of WashingtonWashington | $105.87 | — |
| King County, WAWashington | $116.81 | — |
| WisconsinWisconsin | $100.12 | — |
| West VirginiaWest Virginia | $95.86 | — |
| WyomingWyoming | $102.45 | — |
92609 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.
$95.03
$130.83
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 | $130.83 | 1 |
| AL | $95.88 | 1 |
| AR | $95.03 | 1 |
| AZ | $100.88 | 1 |
| CA | $108.24–$130.93 | 29 |
| CO | $106.40 | 1 |
| CT | $107.63 | 1 |
| DC | $114.56 | 1 |
| DE | $102.13 | 1 |
| FL | $100.42–$105.19 | 3 |
| GA | $96.98–$103.59 | 2 |
| GU | $109.54 | 1 |
| HI | $109.54 | 1 |
| IA | $97.91 | 1 |
| ID | $98.20 | 1 |
| IL | $98.20–$104.56 | 4 |
| IN | $98.57 | 1 |
| KS | $97.37 | 1 |
| KY | $96.73 | 1 |
| LA | $96.53–$99.51 | 2 |
| MA | $106.04–$114.67 | 2 |
| MD | $103.64–$114.56 | 3 |
| ME | $98.25–$101.95 | 2 |
| MI | $98.05–$100.95 | 2 |
| MN | $103.82 | 1 |
| MO | $95.34–$100.04 | 3 |
| MS | $95.21 | 1 |
| MT | $102.54 | 1 |
| NC | $98.93 | 1 |
| ND | $102.34 | 1 |
| NE | $98.32 | 1 |
| NH | $104.64 | 1 |
| NJ | $109.37–$114.06 | 2 |
| NM | $98.28 | 1 |
| NV | $102.54 | 1 |
| NY | $99.84–$115.88 | 5 |
| OH | $98.01 | 1 |
| OK | $96.89 | 1 |
| OR | $102.23–$109.04 | 2 |
| PA | $98.25–$105.64 | 2 |
| PR | $103.11 | 1 |
| RI | $105.18 | 1 |
| SC | $98.53 | 1 |
| SD | $102.32 | 1 |
| TN | $97.64 | 1 |
| TX | $97.83–$105.63 | 8 |
| UT | $99.38 | 1 |
| VA | $101.56–$114.56 | 2 |
| VI | $103.11 | 1 |
| VT | $101.85 | 1 |
| WA | $105.87–$116.81 | 2 |
| WI | $100.12 | 1 |
| WV | $95.86 | 1 |
| WY | $102.45 | 1 |
How the 92609 rate is calculated
Each of 92609’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 · 92609
RVUs × geographic indexes × conversion factor
Work1.50
1.50 RVUs× 1.000 GPCI
Practice expense1.56
1.56 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
3.0700
Conversion factor
$33.4009
Medicare rate
$102.54
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
11,867
- Code
- 92609
- Physician work
- 1.50
- Practice expense
- 1.56
- Malpractice
- 0.01
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.50 | × 1.000 | 1.5000 |
| Practice expense | 1.56 | × 1.011 | 1.5772 |
| Malpractice | 0.01 | × 0.985 | 0.0098 |
| Total RVUs | 3.0870 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Puerto Rico$103.11
Office: (1.5 × 1 + 1.56 × 1.011 + 0.01 × 0.985) × $33.4009 = $103.11
Payment rules and modifiers for 92609
The CMS indicators that decide how 92609 is paid alongside other services.
CMS payment indicators · 92609
Speech device therapy, programming and use training
| 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
92609 without CQ · national office
$102.54
Speech device therapy, programming and use training
92609-CQ · Allowed amount unchanged
$102.54
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 92609 has changed in Puerto Rico
92609 · Office / nonfacility
$103.11
Effective 2026-10-01
The base rate is $1.85 higher than on 2025-10-01, moving from $101.26 to $103.11 (1.8%).
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
$101.26changed to$103.11
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 1.58 changed to 1.56
- Malpractice RVU 0.04 changed to 0.01
- Practice expense GPCI 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$103.53changed to$101.26
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 1.56 changed to 1.58
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$101.84changed to$103.53
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$104.77changed to$101.84
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 1.54 changed to 1.56
- Practice expense GPCI 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$104.37changed to$104.77
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$106.62changed to$104.37
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 1.50 changed to 1.54
- Malpractice RVU 0.07 changed to 0.04
- Practice expense GPCI 1.008 changed to 1.000
- Malpractice GPCI 0.986 changed to 1.000
Held through RVU23B, RVU23C.
January 1, 2022
RVU22A
$107.17changed to$106.62
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 1.51 changed to 1.50
- Malpractice RVU 0.05 changed to 0.07
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$111.57changed to$107.17
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.52 changed to 1.51
- Malpractice RVU 0.06 changed to 0.05
- Malpractice GPCI 0.988 changed to 0.986
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$111.37changed to$111.57
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.53 changed to 1.52
- Malpractice RVU 0.05 changed to 0.06
- Practice expense GPCI 1.007 changed to 1.008
- Malpractice GPCI 0.990 changed to 0.988
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$112.33changed to$111.37
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.56 changed to 1.53
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$103.22changed to$112.33
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.57 changed to 1.56
- Practice expense GPCI 0.856 changed to 1.007
- Malpractice GPCI 0.642 changed to 0.990
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$93.86changed to$103.22
- Conversion factor 35.8043 changed to 35.8887
- Practice expense GPCI 0.705 changed to 0.856
- Malpractice GPCI 0.293 changed to 0.642
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$94.35changed to$93.86
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 1.58 changed to 1.57
- Malpractice RVU 0.04 changed to 0.05
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$93.88changed to$94.35
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$93.33changed to$93.88
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 1.57 changed to 1.58
- Malpractice RVU 0.07 changed to 0.04
- Practice expense GPCI 0.692 changed to 0.705
- Malpractice GPCI 0.271 changed to 0.293
Held through RVU15B.
January 1, 2014
RVU14A
$82.08changed to$93.33
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 1.32 changed to 1.57
- Practice expense GPCI 0.678 changed to 0.692
- Malpractice GPCI 0.249 changed to 0.271
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $82.08
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $103.11 | Not available in this setting | RVU26D |
| 2026-07-01 | $103.11 | Not available in this setting | RVU26C |
| 2026-04-01 | $103.11 | Not available in this setting | RVU26B |
| 2026-01-01 | $103.11 | Not available in this setting | RVU26A |
| 2025-10-01 | $101.26 | Not available in this setting | RVU25D |
| 2025-07-01 | $101.26 | Not available in this setting | RVU25C |
| 2025-04-01 | $101.26 | Not available in this setting | RVU25B |
| 2025-01-01 | $101.26 | Not available in this setting | RVU25A |
| 2024-10-01 | $103.53 | Not available in this setting | RVU24D |
| 2024-07-01 | $103.53 | Not available in this setting | RVU24C |
| 2024-04-01 | $103.53 | Not available in this setting | RVU24B |
| 2024-03-09 | $103.53 | Not available in this setting | RVU24AR |
| 2024-01-01 | $101.84 | Not available in this setting | RVU24A |
| 2023-10-01 | $104.77 | Not available in this setting | RVU23D |
| 2023-07-01 | $104.37 | Not available in this setting | RVU23C |
| 2023-04-01 | $104.37 | Not available in this setting | RVU23B |
| 2023-01-01 | $104.37 | Not available in this setting | RVU23A |
| 2022-10-01 | $106.62 | Not available in this setting | RVU22D |
| 2022-07-01 | $106.62 | Not available in this setting | RVU22C |
| 2022-04-01 | $106.62 | Not available in this setting | RVU22B |
| 2022-01-01 | $106.62 | Not available in this setting | RVU22A |
| 2021-10-01 | $107.17 | Not available in this setting | RVU21D |
| 2021-07-01 | $107.17 | Not available in this setting | RVU21C |
| 2021-04-01 | $107.17 | Not available in this setting | RVU21B |
| 2021-01-01 | $107.17 | Not available in this setting | RVU21A |
| 2020-10-01 | $111.57 | Not available in this setting | RVU20D |
| 2020-07-01 | $111.57 | Not available in this setting | RVU20C |
| 2020-04-01 | $111.57 | Not available in this setting | RVU20B |
| 2020-01-01 | $111.57 | Not available in this setting | RVU20A |
| 2019-10-01 | $111.37 | Not available in this setting | RVU19D |
| 2019-07-01 | $111.37 | Not available in this setting | RVU19C |
| 2019-04-01 | $111.37 | Not available in this setting | RVU19B |
| 2019-01-01 | $111.37 | Not available in this setting | RVU19A |
| 2018-10-01 | $112.33 | Not available in this setting | RVU18D |
| 2018-07-01 | $112.33 | Not available in this setting | RVU18C |
| 2018-04-01 | $112.33 | Not available in this setting | RVU18B |
| 2018-01-01 | $112.33 | Not available in this setting | RVU18AR1 |
| 2017-10-01 | $103.22 | Not available in this setting | RVU17D |
| 2017-07-01 | $103.22 | Not available in this setting | RVU17C |
| 2017-04-01 | $103.22 | Not available in this setting | RVU17B |
| 2017-01-01 | $103.22 | Not available in this setting | RVU17A |
| 2016-10-01 | $93.86 | Not available in this setting | RVU16D |
| 2016-07-01 | $93.86 | Not available in this setting | RVU16C |
| 2016-04-01 | $93.86 | Not available in this setting | RVU16B |
| 2016-01-01 | $93.86 | Not available in this setting | RVU16A |
| 2015-10-01 | $94.35 | Not available in this setting | RVU15D |
| 2015-07-01 | $94.35 | Not available in this setting | RVU15C |
| 2015-04-01 | $93.88 | Not available in this setting | RVU15B |
| 2015-01-01 | $93.88 | Not available in this setting | RVU15A |
| 2014-10-01 | $93.33 | Not available in this setting | RVU14D |
| 2014-07-01 | $93.33 | Not available in this setting | RVU14C |
| 2014-04-01 | $93.33 | Not available in this setting | RVU14B |
| 2014-01-01 | $93.33 | Not available in this setting | RVU14A |
| 2013-10-01 | $82.08 | Not available in this setting | RVU13D |
| 2013-07-01 | $82.08 | Not available in this setting | RVU13C |
| 2013-04-01 | $82.08 | Not available in this setting | RVU13B |
| 2013-01-01 | $82.08 | Not available in this setting | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
92609 billing questions
How does 92609 differ from 92607?
92607 is for evaluating a patient to support a speech-generating device prescription. Use 92609 for therapeutic work on using, programming, or modifying the device.
Can evaluation and device therapy be reported together?
They describe different services. Report both only when the record supports a distinct prescription evaluation and therapeutic device service.
Does 92609 cover programming changes?
Yes. Programming and modification can be part of the skilled therapeutic service when performed to support the patient’s use of the speech-generating device.
Should a professional component modifier be appended?
No. CMS identifies 92609 as a therapy service for which the professional component modifier does not apply.
How does the same-day therapy reduction affect this code?
For the second and later therapy units on the same day, CMS reduces the practice expense portion of payment.
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
Fee sheets
Put 92609 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet