Navigating Medicare’s 2026 Speech Therapy Coding Overhaul in Skilled Nursing Facilities

In July 2026, CMS formally proposed deleting CPT 92507, the generic treatment code speech-language pathologists in skilled nursing facilities have relied on for decades. The plan would replace it with ten time-based, diagnosis-specific codes beginning in 2027. Earlier this year, Medicare added remote therapeutic monitoring codes for SLPs and set a $2,620 combined therapy threshold, after which documentation requirements become more rigorous. These moves collectively recognize that speech therapy is not a one-size-fits-all service, and they demand sharper coding habits from every clinician billing Part B in a SNF.

2026 Medicare Speech Therapy Coding Changes: An Overview

For years, speech-language pathologists in skilled nursing facilities had to lump diverse communication and swallowing disorders under one generic treatment code. Now, CMS is moving toward a model that recognizes distinct clinical presentations, with 2026 as the transition year.

New RTM Categories Arrive

The 2026 Medicare Physician Fee Schedule finalized several updates that directly affect SLPs in SNFs. Most notably, CMS introduced new Remote Therapeutic Monitoring (RTM) categories for speech-language pathology services. These codes allow SLPs to bill for monitoring non-physiologic data, such as adherence to a home exercise program, response to voice therapy, or progress in cognitive-communication strategies, between in-person visits. This addition marks a significant step toward capturing the full scope of SLP interventions, moving beyond traditional face-to-face minutes.

CMS Signals a Shift Toward Granularity

These RTM changes reflect the agency’s broader goal of more accurate, person-centered billing. In 2026, CMS continued to refine therapy modifiers like the GN and KX, emphasizing documentation that justifies medical necessity. The updates also expanded telehealth flexibility for certain SLP services, though the core shift is philosophical: recognizing that speech therapy is not a monolithic service. Instead, it spans distinct impairment categories that deserve their own coding pathways.

Why 2027 Is the Real Pivot

Even as 2026 brings new tools to the billing toolkit, the most historic change lies just ahead. As Renee Kinder detailed in McKnight’s Long-Term Care News¹, CMS has proposed deleting CPT 92507 and replacing it with ten diagnosis-specific treatment codes beginning in 2027. This proposal, currently open for public comment through September 14, 2026, would untether SLP reimbursement from a single, outdated code and align it with the individualized care already delivered at the bedside. The 2026 RTM expansion laid the groundwork; the 2027 deletion of 92507 completes the journey toward a truly modern billing framework.

Remote Therapeutic Monitoring (RTM) Updates for SLPs

Remote therapeutic monitoring has cemented itself as a viable revenue stream for speech-language pathologists in 2026, allowing clinicians to extend care beyond in-person visits and be paid for the data they review.

New RTM Codes for SLPs

Medicare now recognizes a family of RTM codes that SLPs can bill under Part B. The core management code is 98979 (10, 19 minutes of interactive care management per month), with 98980 and 98981 covering longer sessions. Device supply codes let you report the cost of providing FDA-defined monitoring tools:¹

• 98984: Respiratory system device, 2, 15 days
• 98985: Musculoskeletal system device, 2, 15 days
• 98986: Cognitive behavioral therapy device, 2, 15 days

While respiratory and musculoskeletal codes may apply to select dysphagia or myofunctional cases, 98986 is the most common fit for speech-language pathology: supporting cognitive-communication or memory exercises between visits.

What Services Qualify

RTM codes reimburse you for time spent reviewing patient-generated health data from a medical device. This can include self-reported logs, app-based cognitive task performance, or voice recordings uploaded by the patient. At least one real-time interactive communication (phone, video) with the patient or caregiver is required each calendar month.³ The data must be tied to a therapy plan of care, and you cannot bill RTM for a patient you’re not actively treating.

Billing Rules and the GN Modifier

All RTM services billed by an SLP must carry the GN modifier to identify them as therapy services under Medicare Part B.² These codes are designated “sometimes therapy,” so they always require a plan of care and fall under therapy caps if applicable. Importantly, SLPs can bill these codes independently without a physician co-signature, streamlining the reimbursement process.⁴ Documentation standards remain unchanged from prior years: note the device used, data reviewed, clinical decisions made, and time spent. Keep a log of interactive minutes each month.

SNF-Specific Considerations

SLPs working in skilled nursing facilities can bill RTM codes under Part B when the patient is not in a covered Part A stay.³ During a Part A stay, consolidated billing rules apply: the SNF is responsible for providing and billing all services, so RTM generally cannot be billed separately. CMS has not issued guidance specific to SNF RTM billing, so confirm with your Medicare Administrative Contractor before launching a program.² Use proper enrollment and ensure your NPI is linked to the facility’s Part B billing number.

How to Bill RTM Codes With the GN Modifier

Remote Therapeutic Monitoring (RTM) allows SLPs to track and bill for non-face-to-face services under Medicare Part B. Follow this sequence to ensure clean claims and compliance.

SNF Billing Nuances: Consolidated Billing, Part a vs Part B, and Modifiers

In 2026, speech-language pathologists in skilled nursing facilities can bill up to $2,620 in combined physical and speech therapy services under Medicare Part B before a KX modifier is required². That figure is the national therapy threshold, and it shapes how you code every claim in a SNF setting.

How Consolidated Billing Works for SNFs

Under the CMS consolidated billing rule, almost all therapy services furnished to a resident during a Medicare Part A covered stay are bundled into the SNF's payment. Speech-language pathology, physical therapy, and occupational therapy are included; there are no exclusions for SLP services. This means you cannot bill Medicare Part B directly for individual treatment sessions while the patient is in a Part A stay. Evaluation services are likewise bundled. However, if the resident has exhausted their Part A days or is in a Part B-only stay, then speech therapy services can be billed separately under Part B, and that’s where modifiers become critical.

The GN Modifier: Your Key to Part B Claims

For any SLP service billed under Part B in a SNF, you must append the GN modifier. The GN modifier signals that the service was ordered by a physician and is being furnished by a qualified speech-language pathologist under a therapy plan of care. On the claim form, each therapy line item that represents skilled speech therapy should carry the GN modifier. This applies to evaluations, individual treatment sessions, and remote therapeutic monitoring (RTM).³

Billing Examples: Step-by-Step

• Evaluation under Part A: The patient is in a covered Part A stay. The evaluation is included in the bundled payment; do not submit a separate Part B claim.
• Evaluation under Part B: The patient is in a Part B-only stay (non-covered Part A days). Submit the evaluation code with the GN modifier. No KX modifier is needed unless the combined PT and SLP dollar threshold has been reached.
• Individual Treatment under Part A: Same as evaluation, bundled. Do not bill Part B.
• Individual Treatment under Part B: Use the appropriate CPT code with GN modifier.³ Once the $2,620 combined threshold is met, also add the KX modifier to attest that services remain medically necessary.²
• RTM Session: Remote therapeutic monitoring is always a Part B service, even during a Part A stay⁴. Use the 22X type of bill and revenue code 044X⁵. Append both GN and KX modifiers.³ Because RTM counts toward the therapy threshold, you’ll need to track cumulative charges and ensure the KX modifier is present when billing.

The KX Modifier Threshold for 2026

For Medicare Part B therapy services, the annual per-beneficiary combined cap for physical therapy and speech-language pathology is $2,620² (there is a separate $2,620 cap for occupational therapy). This applies to SNF short-stay patients who are under Part B. Once a resident’s total PT and SLP charges reach this amount, you must add the KX modifier to all subsequent claims for that episode. The KX modifier attests that the services are medically necessary and supported by documentation. If the cap is exceeded and KX is omitted, claims will be denied. For RTM, because it is a Part B service, the KX modifier is required from the first session with that revenue code to indicate the service falls under the therapy cap and is medically necessary.

The Coming 2027 CPT 92507 Deletion: What SNFs Must Know

In July 2026, CMS issued a landmark proposed rule that will delete CPT 92507, the catch-all speech therapy treatment code, effective January 1, 2027¹. In its place, the agency plans to introduce 10 new time-based codes organized into five distinct disorder categories¹. This shift directly acknowledges the complexity of SLP care in skilled nursing facilities and ends the one-size-fits-all approach that 92507 represented.

Five Disorder Categories and Their Code Pairs

Each category will have a base code for an initial 30-minute session and an add-on code for each additional 15 minutes. The proposed categories and placeholder code pairs are: - Fluency disorders: base code in the 92X0X range, add-on in the 92X5X range. - Speech sound production disorders: base code in the 92X1X range, add-on in the 92X6X range. - Language comprehension and expression disorders: base code in the 92X2X range, add-on in the 92X7X range. - Combined speech sound production and language disorders: base code in the 92X3X range, add-on in the 92X8X range. - Voice, upper airway dysfunction, and resonance disorders: base code 92X8X (proposed work RVU 0.98), add-on 92X9X (proposed work RVU 0.48).

These proposed codes are designated as "always therapy," meaning they require a therapy plan of care and the appropriate modifier². The multiple procedure payment reduction (MPPR) applies only to the base codes, not the add-ons, which helps protect reimbursement for longer sessions. Final code numbers will be released in fall 2026.

Key Timeline for SNFs

The public has until September 14, 2026 to submit comments on the proposed rule¹. After CMS reviews feedback, it expects to finalize the codes and payment rates by late fall, with implementation on January 1, 2027. Skilled nursing facilities should treat this date as a hard deadline, claims with 92507 will be denied starting 2027.

How SNFs Can Prepare Now

• Staff training: Begin educating SLPs and rehab directors on the proposed disorder-specific codes and documentation requirements. Use the placeholder descriptions to practice mapping current treatment notes to the new categories.
• Documentation templates: Update evaluation and daily note templates to capture the distinct diagnosis supporting each code. This ensures medical necessity and supports skilled service justification.
• Billing system readiness: Coordinate with your billing vendor to confirm it will support the new codes, add-on logic, and MPPR rules by early January. Test claims in December if possible.
• Therapy plan of care: Since the codes are always therapy services, review and reinforce processes for establishing and updating the plan of care, including functional goals aligned with the specific disorder category.

Proactively adapting to these changes will position SNFs to maintain accurate reimbursement and seamless service delivery when 92507 disappears.

How These Changes Affect SLP Reimbursement and Employment

The shift toward time-based and diagnosis-specific reimbursement is reshaping the financial outlook for speech-language pathologists in skilled nursing facilities. Under the 2026 Medicare Physician Fee Schedule, the workhorse treatment code CPT 92507 pays between $75 and $76 per session in non-facility settings¹, while evaluation code 92521 has a stable national rate. New remote therapeutic monitoring codes offer additional billing pathways: CPT 98980 pays $53.77, 98981 pays $41.80, and others range from $21.71 to $39.75 per service². However, a 2.5% efficiency adjustment is cutting work RVUs for many codes, though time-based therapy codes remain exempt, meaning some SLP services may see modest downward pressure this year³.

2026 Payment Landscape and KX Thresholds

The annual therapy cap stands at $2,480 before the KX modifier is required, with a medical review threshold of $3,000⁴. For SLPs, staying within these limits while documenting medical necessity is essential to avoid claim denials. The permanent telehealth status for certain SLP codes also expands service delivery, but reimbursement parity with in-person visits is not guaranteed, potentially affecting per-session income if patients opt for remote sessions at lower rates³.

How Time-Based Coding in 2027 Alters Per-Encounter Revenue

The proposed 2027 code set replaces CPT 92507 with 10 diagnosis-specific, time-based treatment codes. Each disorder category includes a 30-minute base code and a 15-minute add-on code. For a patient with both a language disorder and a speech sound production disorder, an SLP could bill a base code plus an add-on, totaling more RVUs than a single 92507 session today. Conversely, a straightforward fluency case treated in 30 minutes may generate less revenue than the old flat-rate code. This restructures payment around visit complexity and duration, rewarding detailed assessment and multi-faceted care plans.

Coding Accuracy Drives SNF Contract Performance

SNF reimbursement hinges on precise documentation. Miscoding or undercoding not only risks audits but also directly reduces facility revenue. With the 2027 changes, SLPs must map specific ICD-10 diagnoses to the correct new CPT code to capture full payment. Facilities that invest in coder education and therapy software updates will be better positioned to maintain contract rates and avoid payment recoupments. For employed SLPs, demonstrating consistent, compliant billing and earning advanced SLP certifications for skilled nursing strengthens their value during staffing reviews.

SLP Employment Trends: Growth Areas vs. Skilled Nursing

The Bureau of Labor Statistics projects overall SLP employment to grow faster than average through 2033. However, demand within skilled nursing facilities has been flat or slightly declining⁵, as shorter lengths of stay and growth in other SLP work settings shift hiring patterns. The new coding emphasis on complex care may help stabilize SNF roles by validating the need for highly skilled clinicians, but competition for these positions will remain steady. New graduates eyeing SNF settings should focus on mastering medical billing competencies alongside clinical skills to stand out in a disciplined job market.

SLP National Salary Snapshot

Advice for New SLP Graduates Entering Skilled Nursing Facilities

What does it take for a new speech-language pathologist to thrive in a skilled nursing facility when Medicare billing feels like a foreign language? It starts with a mindset shift: SNF reimbursement complexity is not a hurdle to avoid but a specialized skill set that can fast-track your career. By achieving your CCC-SLP certification and mastering documentation, modifiers, and emerging codes, you position yourself as an indispensable clinician in a setting that rewards expertise.

Embrace the Complexity as a Career Accelerator

The layered world of SNF billing, with its consolidated billing rules, Part A stays, Part B maintenance therapy, KX thresholds, and the GN modifier, can feel overwhelming on day one. However, every paperwork challenge is also a chance to demonstrate skilled clinical reasoning. When you learn to document clear functional outcomes tied to each CPT code, you not only support reimbursement but also sharpen your treatment planning. Facilities notice clinicians who can explain why a session meets medical necessity, and that visibility often leads to lead therapist roles or mentoring opportunities.

Secure a Mentor Skilled in SNF Documentation

Early career isolation is common, but it is avoidable. Seek out an experienced SLP supervisor or a rehab director who has weathered coding changes before, someone who can walk you through real-life examples of plan-of-care development, progress notes that pass audit, and how to time KX modifier usage. If your building lacks an SLP mentor, connect with a regional clinical specialist through your employer or reach out to local SLP networks. A knowledgeable guide shortens your learning curve dramatically and helps you avoid billing errors that could flag a claim.

Tap into Professional Networks and Stay Current

Join ASHA’s Special Interest Group 15, Gerontology, where discussions frequently dive into SNF coding dilemmas, productivity trends, and advocacy. The SIG’s online community and resources are gold for new grads. Also, schedule a monthly check-in on CMS updates: set a calendar reminder to review the latest Medicare Learning Network articles or follow trusted industry blogs like McKnight’s. Staying proactive turns regulatory change from a surprise into a planned adaptation.

Build Forward-Looking Skills with RTM and the 2027 Codes

The proposed 2027 CPT code changes, including the deletion of 92507 and the introduction of diagnosis-specific treatment codes, reward clinicians who understand the distinctions between fluency, voice, and language disorders. Start incorporating that mindset now: practice documenting treatment sessions as if the new codes were already active. Similarly, become comfortable with Remote Therapeutic Monitoring (RTM) codes; many SNFs are exploring hybrid care models. New grads who can confidently discuss RTM eligibility, GN modifier pairing, and the proper use of time-based coding for cognitive-communication therapy will stand out in slp interview questions and on the floor.

In short, your first year in an SNF is a launchpad. By treating billing fluency as a clinical competency, aligning with mentors, and keeping one eye on the 2027 coding horizon, you transform a potentially intimidating environment into a fast track for specialization and leadership.

Frequently Asked Questions About Medicare Speech Therapy Coding

Medicare speech therapy coding is evolving rapidly: new codes, modifier rules, and threshold amounts can be confusing. We address common questions below, but be sure to verify with official sources for the most current billing and coverage policies.

When will Medicare stop using CPT 92507?

CPT 92507 is valid through December 31, 2026. It will be deleted on January 1, 2027, and replaced by 10 new diagnosis-specific treatment codes.¹

What is the KX modifier threshold for speech therapy in 2026?

The 2026 threshold is $2,480. Once therapy services reach that amount, you must add the KX modifier to claims as an attestation of medical necessity.²

What is RTM and how does it apply to speech therapy?

Remote Therapeutic Monitoring (RTM) allows SLPs to monitor patients’ therapy progress remotely. For 2026, new RTM codes include CPT 98984, 98985, and 98979, which can be billed with the GN modifier for speech-language pathology services.³

Where can I find official Medicare billing guidance for speech therapy?

For detailed coding rules and coverage criteria, consult the Medicare Benefit Policy Manual (Chapter 15, Section 220) and CMS’s Medicare Learning Network (MLN). These resources provide the most current billing and documentation requirements.

How do the 2027 coding changes affect SNF billing?

The deletion of CPT 92507 means SNFs must use new treatment codes tailored to each disorder. This shift requires updated documentation and may affect reimbursement, but it better captures the complexity of SLP services. Providers should monitor CMS updates for implementation details.

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