2026 Speech Therapy Billing Changes: CPT Updates, Modifiers & Compliance Rules

How prepared is your speech therapy practice for the latest Medicare billing updates in 2026?

Each year, changes to CPT codes, modifiers, and compliance rules can significantly affect how Speech-Language Pathology (SLP) services are documented, billed, and reimbursed. Even small updates in coding guidelines or monitoring requirements can influence claim approval rates and overall revenue cycle performance.

Due to these evolving regulations, SLP providers and billing teams must stay informed to ensure accurate claims submission and regulatory compliance. In fact, failing to adapt to new billing rules can increase the risk of claim denials, delayed reimbursements, or audit issues.

In this blog, we will explore the key 2026 speech therapy billing changes, modifier requirements, and compliance rules that Speech-Language Pathologists should understand.

CPT Code Updates for Speech Therapy

The 2026 Medicare updates introduce several important changes to CPT codes used in speech therapy billing. In fact, these changes allow providers to report services more precisely while supporting modern therapy delivery methods.

• RTM Expansion

One of the most important updates in 2026 is the expansion of Remote Therapeutic Monitoring services. Previously, RTM required longer monitoring periods, which limited its practical use in therapy. However, the new rules now allow providers to bill for shorter monitoring durations, making remote therapy management more accessible and clinically useful.

• New RTM Device Codes

CMS introduced new CPT codes 98984 and 98985 to allow billing for RTM device supply during shorter monitoring periods. These codes apply when monitoring occurs for two to fifteen days within a thirty-day period. As a result, therapists can now report short-term remote monitoring activities that previously could not be billed.

• RTM Management Code

A new treatment management code, 98979, has been added to report clinician time spent managing RTM services. This code represents the first ten minutes of professional time within a calendar month. Therefore, providers can document and bill smaller increments of remote monitoring management activities more accurately.

• Revised RTM Codes

Existing RTM device supply codes 98976 and 98977 have been revised to clearly represent longer monitoring durations. These codes now specifically apply when monitoring occurs for sixteen to thirty days within a thirty-day period. Consequently, providers must select the appropriate code based on the actual duration of remote monitoring performed.

• Hearing Device Codes

Another important update involves the replacement of older hearing device service codes. The previous codes 92590 through 92595 have been removed and replaced with twelve new CPT codes ranging from 92628 to 92642. These codes better reflect modern hearing device programming, evaluation, and management services performed by clinicians.

• ICD-10 Diagnosis Updates

New ICD-10 diagnosis codes have been introduced for conditions affecting speech and language. For example, codes now exist for Primary Progressive Apraxia of Speech (PPAOS) and certain genetic disorders. These updates improve diagnostic accuracy and support clearer documentation when reporting speech therapy services.

Modifiers and Billing Compliance Rules

CMS has also revised several billing compliance rules affecting speech therapy services in 2026. These changes involve therapy spending thresholds, modifier requirements, telehealth billing standards, supervision policies, and documentation expectations. Therefore, providers must understand these requirements carefully to maintain compliance and avoid claim denials.

• KX Modifier Threshold

The combined therapy threshold for Speech-Language Pathology and Physical Therapy services is $2,480 for 2026. In fact, the providers must append the KX modifier to subsequent claims once a patient’s therapy services exceed this amount during the year. This modifier confirms that the services remain medically necessary and properly documented.

• Medical Review Threshold

CMS continues to monitor high therapy spending through a targeted medical review process. If a patient’s combined therapy costs exceed $3,000 during a calendar year, the claim may be selected for additional review. Therefore, providers should maintain clear documentation that supports medical necessity, treatment progress, and ongoing therapy goals.

• Therapy Modifiers

Speech therapy services must include the correct discipline modifier to indicate which therapy type is being billed. Proper modifier use ensures that claims are processed correctly and assigned to the appropriate therapy discipline.

The appropriate therapy modifier must also be applied, including:

• GN – Speech-Language Pathology services
• GP – Physical Therapy services
• GO – Occupational Therapy services
• Assistant Modifiers

When therapy assistants participate in treatment, specific modifiers must be used to report their involvement. The CQ modifier identifies services performed by a Physical Therapist Assistant, whereas CO represents Occupational Therapy Assistant services. Furthermore, the ten percent de minimis rule applies when assistants provide more than ten percent of the total service time.

• Supervision Policy

CMS continues to allow general supervision for Physical Therapist Assistants and Occupational Therapy Assistants in outpatient private practices. Under this rule, the supervising therapist does not need to be physically present during treatment. However, the therapist must remain responsible for the overall direction, plan of care, and supervision of therapy services.

• Telehealth Requirements

Telehealth services remain an important option for delivering speech therapy in 2026. However, CMS requires that telehealth visits include real-time audio and visual communication between the provider and patient. Therefore, clinicians must use approved technology platforms and clearly document that the therapy session occurred through interactive telehealth communication.

• Documentation Requirements

Accurate documentation is essential for compliant speech therapy billing under the updated rules. Providers must record:

• RTM device-generated patient data
• Clinician interpretation of the collected information
• Patient communication or interaction related to therapy
• Time spent managing remote monitoring services

Additionally, documentation should support medical necessity, especially when therapy services exceed annual spending thresholds.

2026 Compliance Checklist for SLPs

The 2026 billing updates require Speech-Language Pathologists to adjust their documentation, coding systems, and monitoring processes. In fact, following a structured compliance checklist can help practices stay aligned with the latest Medicare requirements while minimizing billing errors and claim denials. The following steps can help SLPs maintain accurate reporting and regulatory compliance:

• Update EMR Systems

Practices should first update their Electronic Medical Record systems to reflect the latest coding changes. This includes adding the new RTM codes 98984, 98985, and 98979 along with the revised descriptors for existing monitoring codes. In fact, updated systems help ensure that clinicians and billing teams select the correct codes when documenting and submitting therapy services.

• Document RTM Services

Accurate documentation is essential when reporting Remote Therapeutic Monitoring services. Clinicians must clearly record device-generated patient data, the provider’s clinical interpretation of the collected information, and the time spent managing remote therapy activities. Proper documentation ensures that RTM services meet Medicare billing requirements and supports medical necessity during audits.

• Review ICD-10 Coding

Speech therapy providers should review their diagnostic coding practices to reflect newly introduced ICD-10 codes. In fact, conditions such as Primary Progressive Apraxia of Speech (PPAOS) and other speech-related disorders may now have more specific diagnostic codes. Using updated codes helps improve claim accuracy and ensures documentation reflects the patient’s exact clinical condition.

• Monitor Therapy Thresholds

Practices must closely track the $2,480 therapy threshold that applies to combined Speech-Language Pathology and Physical Therapy services. Once this limit is exceeded, the KX modifier must be added to claims to confirm medical necessity. Monitoring therapy spending throughout the year helps providers avoid billing mistakes and potential compliance issues.

• Consider Outsourcing Billing

Managing frequent coding updates, documentation rules, and modifier requirements can be challenging for many practices. Therefore, some providers choose to outsource speech therapy billing and coding services to 24/7 Medical Billing Services. In fact, outsourcing can help ensure accurate coding, timely claim submission, and consistent compliance with Medicare billing guidelines.

FAQs

How can speech therapy practices prepare for annual billing updates?

Practices can prepare by reviewing CMS updates early, training staff on coding changes, and updating billing workflows before the new year begins.

How often should speech therapy billing processes be reviewed?

Billing workflows should be reviewed regularly, especially after major CMS updates or when new therapy services are introduced.

How can practices reduce claim denials for speech therapy services?

Regular coding audits, proper documentation, and staff training can significantly reduce the risk of denied claims.