Billing code 92526: Swallowing therapyMedicare rate & RVUs in Illinois
Skilled therapy for swallowing dysfunction or oral feeding impairment, reported when treatment addresses the patient’s swallowing or feeding function.
Medicare pays $80.96–$85.80 for 92526 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. 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.
On this page 9 sections
What 92526 covers
92526 represents skilled therapeutic intervention for impaired swallowing or oral function used for feeding. A speech-language pathologist commonly provides it for dysphagia after stroke, neurologic disease, or head and neck treatment, and for children with feeding-related oral-motor difficulty. Treatment may include swallowing practice, compensatory strategies, and exercises selected for the patient’s functional deficits. This is therapy, not a swallowing evaluation or an instrumental study, and may be provided in outpatient or facility settings.
Report the service for a treatment session, with documentation of the swallowing or feeding problem, skilled interventions, goals, and the patient’s response. It is generally an untimed service, reported as one unit per session rather than in 15-minute increments. CMS treats it as a therapy service, so a professional component modifier does not apply. When it is among multiple therapy services on the same day, the practice expense for the second and later therapy units is reduced under the therapy multiple procedure payment reduction.
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 92526 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$80.96 to $85.80
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $85.11 | Unavailable |
| East St. Louis | $81.38 | Unavailable |
| Rest Of Illinois | $80.96 | Unavailable |
| Suburban Chicago | $85.80 | Unavailable |
How the 92526 rate is calculated
Each of 92526’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 · 92526
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.34Practice expense 1.17Malpractice 0.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 92526
The CMS indicators that decide how 92526 is paid alongside other services.
CMS payment indicators · 92526
Swallowing therapy
| 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
92526 without CQ · national office
$84.17
Swallowing therapy
92526-CQ · Allowed amount unchanged
$84.17
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.
92526 compared with similar codes
Compare codes
92526 vs 92507 vs 92610 vs 92611: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 92507Speech therapy
- 92507 is treatment for speech, language, voice, or communication goals. Use 92526 for treatment directed at swallowing dysfunction or oral function for feeding.
- 92610Swallow evaluation
- 92610 reports a clinical swallowing evaluation; 92526 reports skilled treatment. The service performed, not just the diagnosis, determines the choice.
- 92611Swallow study
- 92611 is a videofluoroscopic swallowing evaluation. It documents swallowing function through imaging, whereas 92526 reports therapeutic intervention.
92526 billing questions
How is 92526 different from 92507?
Use 92526 when skilled treatment targets swallowing or oral function for feeding. Use 92507 when the treatment targets speech, language, voice, or communication.
Is 92526 an evaluation code?
No. It reports treatment. Code 92610 is used for a clinical evaluation of oral and pharyngeal swallowing function.
Can modifier 26 be appended?
No. CMS identifies 92526 as a therapy service without a professional component modifier.
Is the service billed in 15-minute units?
No. It is generally reported as one unit per treatment session, not in 15-minute increments.
What happens when multiple therapy services are billed on the same day?
CMS reduces practice expense for the second and later therapy units on that day. The reduction applies when 92526 falls among those later units.
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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