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Billing code 92521: Speech evaluationMedicare rate & RVUs

A speech-language pathologist evaluates fluency problems such as stuttering or cluttering to characterize communication difficulties and guide care.

CMS RVU26DEffective Oct 1, 2026109 payment localities490 Medicare services in 2024

Medicare pays $133.27 for 92521 nationally in the office. Local office rates run $124.91–$174.31.

Medicare rate · 92521

Speech evaluation

Swap in your local Medicare rate.

Work RVUs
2.24
Total RVUs
3.99
Global days
XXX

National rate · 2026

$133.27

Office setting, before claim adjustments.

See every locality for 92521 → · Billed by an NP, PA or therapist? →

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 10 sections
  1. Medicare rate
  2. What 92521 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

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

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 payment localities

$124.91 to $174.31

$124.91$149.61$174.31
One dot per payment locality, office / nonfacility. Hover a dot to see the locality; select it to open that rate.

109 of 109 payment localities

92521 office and facility rates by payment locality
Payment localityOfficeFacility
Alabama$125.86Unavailable
Alaska*$174.31Unavailable
Arizona$131.42Unavailable
Arkansas$124.91Unavailable
Atlanta$134.49Unavailable
Austin$136.75Unavailable
Bakersfield$140.14Unavailable
Baltimore/Surr. Cntys$138.79Unavailable
Beaumont$128.02Unavailable
Brazoria$133.27Unavailable

92521 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
92521 office rate range by state
State / territoryOffice rate rangeLocalities
AK$174.311
AL$125.861
AR$124.911
AZ$131.421
CA$139.97–$167.0329
CO$137.811
CT$139.311
DC$147.691
DE$132.911
FL$130.88–$136.163
GA$127.06–$134.492
GU$141.091
HI$141.091
IA$128.131
ID$128.441
IL$128.40–$135.624
IN$128.861
KS$127.521
KY$126.791
LA$126.57–$129.892
MA$137.48–$147.582
MD$134.69–$147.693
ME$128.49–$132.622
MI$128.26–$131.462
MN$134.721
MO$125.24–$130.483
MS$125.101
MT$133.271
NC$129.261
ND$133.071
NE$128.591
NH$135.611
NJ$141.64–$147.302
NM$128.511
NV$133.271
NY$130.26–$149.335
OH$128.221
OK$126.981
OR$132.94–$140.832
PA$128.49–$137.062
PR$133.901
RI$136.571
SC$128.801
SD$133.051
TN$127.831
TX$128.02–$136.758
UT$129.751
VA$132.18–$147.692
VI$133.901
VT$132.521
WA$137.24–$150.142
WI$130.601
WV$125.801
WY$133.181

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

Swap in your local Medicare rate.

Work 2.24Practice expense 1.74Malpractice 0.01

3.9900 adjusted RVUs×$33.4009 conversion factor=$133.27

All indexes start 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

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures5Therapy reduction: practice expense of the second and later units is reduced.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical7Therapy 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

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

92521 vs 92522 vs 92523 vs 92524: national Medicare rates

Swap in your local Medicare rate.

  • 92521
    Speech evaluation · 2.24 wRVU
    $133.27
  • 92522
    Speech evaluation · 1.92 wRVU
    $111.89−$21.38
  • 92523
    Speech-language evaluation · 3.84 wRVU
    $226.46+$93.19
  • 92524
    Voice evaluation · 1.92 wRVU
    $109.55−$23.72

How to choose

92522Speech evaluation
Choose 92521 for a fluency assessment, such as evaluation of stuttering. Choose 92522 when the assessment centers on speech sound production.
92523Speech-language evaluation
92523 covers speech sound production together with language comprehension and expression; 92521 focuses on fluency.
92524Voice evaluation
92524 assesses voice quality and related vocal characteristics. 92521 is for evaluation of speech fluency.

Codes related to 92521

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 92521
CodeHow it relatesNational office range
Same family
92522Speech evaluationSpeech evaluation focused on production of speech sounds.$104.70–$146.38
92523Speech-language evaluationSpeech and language evaluation covering speech sounds and language.$212.50–$296.80
92524Voice evaluationEvaluation focused on behavioral and qualitative aspects of voice.$102.81–$144.06

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
RVUs for 92521PPRRVU2026_Oct_nonQPP.csv, line 11,788 (RVU26D)

Open CMS sourceHow we calculate rates

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