Out-of-network provider
TLC Speech Therapy is a private-pay practice. Speech, language, and feeding therapy provided by TLC Speech Therapy is considered out-of-network. This means we do not bill insurance directly. Many families submit documentation to their insurance for reimbursement.
What is a superbill?
After each session, we can provide you with a superbill. This is an itemized receipt that includes:
- The date and type of service
- The cost of the session
- Billing (CPT) codes that describe the service provided
- Diagnosis (ICD-10) codes that explain the reason for therapy
- The provider’s information, including NPI number
You can submit superbills to your insurance company to request reimbursement. Whether you receive reimbursement depends entirely on your specific insurance plan.
Session fees
$350
Initial evaluation
about 60 minutes
$150
Therapy session
about 45 minutes
Understanding codes (CPT and ICD-10)
Insurance companies require standardized codes to process claims. CPT codes describe what service was provided. ICD-10 codes describe why services are needed (the diagnosis). After the evaluation, we will select the most appropriate diagnosis code or codes.
| 92523 | Evaluation of speech sound production and language |
|---|---|
| 92522 | Evaluation of speech sound production only |
| 92521 | Evaluation of speech fluency (stuttering) |
| 92524 | Evaluation of voice and resonance |
| 92610 | Evaluation of swallowing and oral function for feeding |
| 96105 | Assessment of aphasia |
| 92507 | Individual treatment of speech, language, voice, or communication |
| 92508 | Group treatment of speech, language, voice, or communication |
| 92526 | Treatment of swallowing and oral function for feeding |
| F80.0 | Phonological disorder (sound production issues) |
|---|---|
| F80.1 | Expressive language disorder (trouble speaking or forming messages) |
| F80.2 | Mixed receptive-expressive language disorder (trouble understanding and using language) |
| F80.81 | Childhood-onset fluency disorder (stuttering) |
| R48.2 | Apraxia, including childhood apraxia of speech |
| R47.01 | Aphasia |
| I69.320 | Aphasia following a stroke |
| R47.1 | Dysarthria |
| R13.11 | Dysphagia (swallowing difficulty), oral phase |
| R13.12 | Dysphagia (swallowing difficulty), oropharyngeal phase |
| R63.31 | Pediatric feeding disorder, acute |
| R63.32 | Pediatric feeding disorder, chronic |
When you call your insurance, we recommend asking which ICD-10 code they prefer. They may or may not have input, but a few different codes may apply and they may prefer one. This does not change the type of therapy or the therapy goals in any way.
Some insurance plans also require a modifier to show that services were provided in-person. This varies by plan. Your insurance can tell you, and we will make sure it's added to your superbill.
Questions to ask your insurance
Print this page for a call sheet with space to write down the answers. If you would like to pursue reimbursement, call your insurance company and ask:
- 1.Do I have out-of-network benefits for speech therapy?
- 2.What percentage of the cost is reimbursed?
- 3.Is there a deductible I need to meet first?
- 4.Do I need pre-authorization for services?
- 5.Do I need a prescription from my pediatrician or doctor?
- 6.Are CPT codes 92507 and 92523 covered?
- 7.Which ICD-10 diagnosis code do you prefer?
- 8.Do you require any modifiers for in-person services?
- 9.Is there a limit on the number of visits per year?
A quick note
We are happy to provide all necessary documentation, but we cannot communicate directly with insurance companies or guarantee reimbursement. Insurance companies will not share plan information with us, so we are not able to look up the details of your plan. Each plan is different, but many families do receive partial reimbursement after submitting superbills.
Questions about billing?
Contact us