Billing and Coding: A Primer for Clinicians
Billing and Coding: A Primer for Clinicians
Published in the September 2025 issue of the ISHA Voice.
By Stephanie Mulholland and Susannah York
For new and experienced clinicians alike, many speech-language pathologists and audiologists feel underprepared or underinformed about what coding for reimbursement means. When a supervisor, special education administrator, or director of rehabilitation says, “enter the code for the diagnosis,” or “you forgot the procedure code,” what does that mean?
The purpose of this article is to provide an overview regarding coding for reimbursement, along with resources for SLPs and audiologists. In future articles, we will delve into more specifics and answer more questions.
The Importance of Diagnostic Accuracy and Billing Knowledge
Why do SLPs and audiologists need to know about billing, coding, and reimbursement, especially if not in an administrative role? All clinicians, regardless of their role in an institution, agency, and across settings, require knowledge of billing and coding. Understanding the impact of your diagnostic decisions and how they impact coding is essential for ethical and sustainable practice. Diagnostic coding directly influences service eligibility, reimbursement, and need for continued care. The accurate identification and reporting of a client’s condition through diagnostic coding ensures medical necessity and supports data-driven clinical decision-making across occupational settings. Likewise, a solid grasp of procedural coding allows providers to bill correctly, avoiding audits and denials and ensuring appropriate compensation for skilled services.
Getting started with Medical Coding
We will focus on two main types of coding in this article, procedural coding and diagnostic coding.
Procedure and Diagnostic Codes
One type of code describes the procedure being performed by a clinician; these are referred to as CPT codes, or Current Procedural Terminology Codes, which are maintained by the American Medical Association. These are five-digit codes, and are often referred to as simply ‘procedure codes.’ There are a number of commonly used CPT codes for SLPs and audiologists, and clinicians can access them easily on the ASHA website for more complete descriptions.
Timed vs. Untimed Codes
Most speech-language pathology CPT codes are ‘untimed,’ which means that one code equals one session. A common example is CPT code 92507, speech and language treatment. The time of a ‘session,’ is not determined by any one factor, but instead the clinical decision-making of the treating therapist and guidelines of the setting. Similarly, many common audiology procedure codes are also untimed. SLPs and audiologists may be confused as other allied health professions, such as physical therapy and occupational therapy, have more frequently used timed codes.
Diagnostic Codes
In addition to procedural codes, diagnostic codes are also critically important for SLPs and audiologists to use correctly. As noted above, diagnostic codes are utilized to support medical necessity for various payers and stakeholders, and accurate and ethical diagnostic coding is essential. Diagnostic codes are taken from the International Classification of Diseases, currently in its 10th edition, or the ICD-10. Each updated edition of the ICD manual includes new and modified diagnostic codes. Comprehensive lists of ICD-10 codes are available online, but clinicians should know that ASHA has culled through thousands of codes to create guides for the most commonly applicable diagnostic codes for speech-language pathology and audiology.
Learning about procedure and diagnostic codes can be overwhelming. In addition to print resources, ASHA also has produced a number of video modules that are publicly available and may be useful to both new and experienced therapists. They are provided in the resources below.
Frequently Asked Questions
There are a number of frequently asked questions regarding basic principles of billing and coding:
What do I do if my administrator tells me I need to change a diagnostic code so it is covered by insurance?
In a recent article from our committee, Ethical Dilemmas in Billing and Coding, we discussed frustrations around diagnostic code denials from insurance companies. While frustrating for clients and providers alike, changing diagnostic codes for reimbursement is unethical and per most insurance contracts, fraudulent. Clinicians are urged to remind their administrators that as autonomous, licensed health care professionals, SLPs and audiologists must honor their ethical obligations when it comes to diagnosing patients appropriately.
I am a school-based therapist. Why am I being asked to bill Medicaid?
Not all states or school districts participate in Medicaid billing. School-based health services are an eligible service for Medicaid billing, and school-based clinicians may be asked to enter codes and other documentation to support funding. As such, it is important that school-based SLPs and audiologists understand diagnostic coding.
I frequently hear about ‘developmental’ diagnostic codes. What does that mean?
ICD-10 codes beginning with F80 come from a series that is used for speech/language deficits that are not due to an underlying medical condition. For example, a child may be referred to the Early Intervention program due to concerns about delayed expressive language skills and have a diagnostic code of F80.1, indicating there is no underlying medical condition associated with the child’s delay. This series of codes are different from other types of diagnostic codes, which are utilized when there is an underlying medical condition causing or associated with a speech/language deficit.
What is the difference between the different OAE CPT codes?
There are 3 distinct CPT codes for billing OAE to distinguish between OAE screening, limited OAE, and comprehensive evaluation OAE. ASHA has an FAQ document available specifically for helping audiologists distinguish among these codes accurately available here.
Our clinic received a referral from a physician but their diagnostic code does not match our assessment results. What should we do?
Remember that as independent health care providers, SLPs and Audiologists provide their own diagnostic information. While a physician may send a referral with an originating diagnosis, your diagnosis as a clinician is ultimately what is appropriate for billing and documentation purposes.
Final Thoughts
SLPs and audiologists may have times where they feel confused about how to code ethically and appropriately, or have concerns about practice requirements in their settings. ASHA is available for these questions at reimbursement@asha.org. This committee can be contacted by email at membership@ishail.org with indication that your question is for the billing and reimbursement committee.
Resources
ASHA Billing and Reimbursement Page
ASHA’s Coding for Reimbursement ICD-10 resources
Audiologists can find information on many billing and coding issues on ASHA’s website with additional information available through the Academy of Doctors of Audiology as well as the American Academy of Audiology.
