Summary & Overview
CPT 92610: Evaluation of Oral and Pharyngeal Swallowing Function
CPT code 92610 is a critical billing code used for the evaluation of oral and pharyngeal swallowing function, a procedure that plays a central role in diagnosing and managing swallowing disorders such as dysphagia. This service is commonly performed by speech-language pathologists and other rehabilitation professionals in outpatient office settings. Nationally, the code is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, ensuring broad coverage for patients requiring this assessment.
The publication provides a comprehensive overview of 92610, including payer coverage, clinical context, and policy updates relevant to reimbursement and utilization. Readers will gain insight into typical sites of service, associated clinical specialties, and the importance of this evaluation in the continuum of care for patients with swallowing difficulties. The summary also highlights related codes and modifiers, offering clarity on billing nuances and documentation requirements. Benchmarks and trends in utilization are discussed to inform stakeholders about the evolving landscape of swallowing function evaluations. This resource is designed to support healthcare professionals, administrators, and policy analysts in understanding the national significance and operational details of CPT code 92610.
CPT Code Overview
CPT code 92610 represents the evaluation of oral and pharyngeal swallowing function. This procedure is classified under Special Otorhinolaryngologic Services and Procedures and is typically performed in an office setting (Place of Service 11). The evaluation is essential for assessing swallowing difficulties and guiding further management for patients experiencing dysphagia or related conditions.
Clinical & Coding Specifications
Clinical Context
A patient presents to the office with complaints of difficulty swallowing, such as coughing during meals, sensation of food sticking in the throat, or unexplained weight loss. The provider, typically a speech-language pathologist, conducts a comprehensive evaluation of the oral and pharyngeal swallowing function. This assessment may include a detailed history, physical examination, and standardized swallowing tests to determine the nature and severity of dysphagia. The evaluation is performed in an office setting and is essential for developing an appropriate treatment plan.
Coding Specifications
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Modifier
GN: Indicates services delivered under an outpatient speech-language pathology plan of care. Used when the evaluation is part of a therapy plan, often required by payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare. -
Modifier
52: Used to report reduced services when the evaluation is not performed in its entirety.
| Modifier Code | Description |
|---|---|
GN | Services delivered under an outpatient speech-language pathology plan of care |
52 | Reduced Services |
Associated Provider Taxonomies:
235Z00000X- Speech-Language Pathologist261QH0700X- Hearing and Speech Clinic/Center225X00000X- Rehabilitation Practitioner
These taxonomies represent providers specializing in speech-language pathology, hearing and speech clinics, and rehabilitation services.
Related Diagnoses
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R13.10- Dysphagia, unspecified- Used when the specific phase of swallowing difficulty is not determined. Relevant for initial evaluations.
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R13.11- Dysphagia, oral phase- Indicates difficulty during the oral phase of swallowing, such as problems with chewing or moving food to the back of the mouth.
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R13.12- Dysphagia, oropharyngeal phase- Refers to difficulty in the transition from the mouth to the pharynx, often assessed during swallowing evaluations.
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R13.13- Dysphagia, pharyngeal phase- Represents issues in the pharyngeal phase, such as impaired muscle coordination or reflexes.
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R13.14- Dysphagia, pharyngoesophageal phase- Used for swallowing difficulties at the junction of the pharynx and esophagus, relevant for comprehensive swallowing assessments.
Each diagnosis code is directly relevant to the evaluation of oral and pharyngeal swallowing function performed with CPT code 92610.
Related CPT Codes
| CPT Code | Description |
|---|---|
92611 | Motion fluoroscopic evaluation of swallowing function by cine or video recording |
92612 | Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording |
92614 | Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording |
92616 | Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording |
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92611is often used when a fluoroscopic (video x-ray) assessment is needed to visualize swallowing mechanics, typically following or in conjunction with the clinical evaluation (92610). -
92612,92614, and92616involve endoscopic techniques to directly observe swallowing and laryngeal function. These codes may be used as alternatives or adjuncts to92610when more detailed visualization is required. -
These related codes are commonly used together in complex cases or as alternatives depending on the clinical need and available resources.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 92610 is highest with UnitedHealth Group at $139.12, while Medicare's mean rate is $87.93. The average commercial benchmark (BUCA) stands at $112.15, which is notably higher than the Medicare mean rate.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Medicare shows the tightest range ($7.00), indicating less variability in rates, while UnitedHealth Group and Cigna have the widest dispersions ($79.33 and $70.75, respectively), reflecting greater variability in commercial reimbursement.
The table and chart below present a detailed breakdown of national payer benchmarks for CPT code 92610, including mean rates and percentile values.
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