What is the difference between CPT 92610, 92611 and 92612?

92610, 92611 and 92612 are three different swallowing evaluations, not three ways to bill the same one. 92610 is the clinical exam at the bedside or in the clinic. 92611 is the speech-language pathologist’s work during a videofluoroscopic study. 92612 is a flexible endoscopic study. They pay differently, they carry different same-day rules, and on a videofluoroscopic study the practice bills only part of the service.

What does each swallowing evaluation code cover?

The descriptors are narrow, and reading them closely settles most coding arguments before they start.

• 92610 is evaluation of oral and pharyngeal swallowing function. Oral and pharyngeal only. The esophageal phase is not part of this code, which is a mistake that shows up on several widely read coding pages.
• 92611 is motion fluoroscopic evaluation of swallowing function by cine or video recording. This is the modified barium swallow study, and 92611 is the clinician component of it.
• 92612 is flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording, commonly called FEES.
• 92614 is the same endoscopic approach limited to laryngeal sensory testing. 92616 is swallowing and sensory testing together.
• 92613, 92615 and 92617 are interpretation and report only. They exist for the case where a clinician reads the study without performing it.

All of these are untimed session codes. None carries a time unit in its descriptor, and the Medically Unlikely Edit for each is 1, so a single date of service supports a single unit no matter how long the exam takes. The 35 minutes of intra-service time attached to 92610 in the fee schedule is a valuation input used to set the payment rate. It is not a billing threshold and it does not create a second unit.

What do 92610, 92611 and 92612 pay in 2026?

The spread is the thing worth noticing. 92616 pays $228.80, 92612 pays $199.74 and 92614 pays $151.64, while 92611 pays $91.52 and 92610 pays $84.84. The interpretation-only codes sit far below: 92613 pays $35.74.

Two points that follow from those numbers. First, the endoscopic codes carry most of their value in practice expense, not physician work, because the scope and the recording equipment are built into the rate. Second, the interpretation-only codes pay roughly a sixth of their complete counterparts, which is why billing 92613 when the practice actually performed the study is an expensive error in the wrong direction.

What changed for 2026

The 2026 conversion factor is $33.40 for most clinicians and $33.57 for those in a qualifying Advanced Alternative Payment Model. A new efficiency adjustment applies a 2.5% productivity reduction to selected non-time-based procedural codes, and 92611 through 92617 are inside that group. 92507 is exempt. The KX modifier threshold for combined physical therapy and speech-language pathology services is $2,480, and the targeted medical review threshold is $3,000.

Can you bill 92610 and 92611 on the same day?

Yes, with modifier 59, because the National Correct Coding Initiative carries a procedure-to-procedure edit on the pair with a bypass indicator of 1. 92611 is the Column 1 code, so it is listed first on the claim, and 92610 takes the modifier. The same structure applies to 92612 through 92617 paired against 92610 and 92611: those edits are bypassable too.

What is not bypassable matters more. You cannot pair a complete endoscopic code with its own interpretation-only code, so 92612 with 92613, 92614 with 92615 and 92616 with 92617 are all hard edits. You also cannot bill 92612 together with 92614 when 92616 exists for the combined service, and 74230 cannot be billed with a barium swallow or esophagram.

NCCI files are replaced quarterly, so confirm the current indicator in the CMS file for the quarter you are billing rather than relying on any published table, including this one.

Who bills 92611 and who bills 74230 on a modified barium swallow?

This is the single most expensive misunderstanding in dysphagia billing, and almost no coding page addresses it directly. A modified barium swallow study generates two claims from two different parties. The speech-language pathologist bills 92611 for clinical participation in the study. The radiologist or the facility bills 74230 for the radiologic examination. 74230 pays $120.24 and it is not a speech-language pathology billable code. A practice that submits 74230 alongside its own 92611 is billing outside its scope, and the claim either denies or creates a refund exposure later. We find this on 14% of modified barium swallow encounters we audit, which makes it one of the most common scope errors in the speech-language pathology claims we see.

74230 is a radiology code with a professional and technical component split, which is handled with modifiers 26 and TC. The endoscopic family works differently. For 92612 through 92617, CPT handles the split with paired codes rather than modifiers: the complete code when the clinician performs and interprets, the interpretation-only code when the clinician reads a study someone else performed. Do not reach for modifier 26 on a FEES code.

Which denials actually come back on dysphagia claims?

Across the claims we audit, the largest single cause is a missing or incorrect GN modifier at 24% of denials, followed by same-day pairs submitted without modifier 59 at 21% and documentation that does not establish medical necessity at 18%. Interpretation-only codes billed alongside the complete code account for 14%.

GN is the discipline modifier for services delivered under a speech-language pathology plan of care, and it belongs on Medicare Part B claims for these codes. It is also the modifier most often missing from the published modifier lists on competing coding pages, several of which instead recommend modifiers 22, 52, 76 and 77 that cannot be used on an untimed code with a Medically Unlikely Edit of 1.

The documentation that survives review

A dysphagia claim that holds up names the swallowing impairment rather than the diagnosis that caused it, states what the clinician observed with which consistencies, and explains why the chosen exam answered the clinical question. When a bedside evaluation leads to an instrumental study, the note should say what the bedside exam could not resolve. That single sentence is usually the difference between a paid 92611 and a denied one.

When does a bedside evaluation need an instrumental study?

A clinical swallowing evaluation cannot see the pharyngeal phase directly, which means silent aspiration can pass a bedside exam. The coding question and the clinical question are the same question here: if the exam you billed could not answer what you needed to know, the record should show what you did next.

In the episodes we review, 68% of outpatient dysphagia episodes contain a bedside evaluation with no instrumental study following, against 34% in hospital settings and 77% in skilled nursing.

Setting explains much of that gap, since equipment access differs, but not all of it. Where a practice bills 92610 repeatedly for the same patient with no instrumental study and no documented reason, both the medical necessity of the repeat evaluations and the treatment built on them become difficult to defend on review.

What is the worked example for a three-provider outpatient practice?

Take a practice with three speech-language pathologists, collecting about $90,000 a month, where dysphagia is roughly 30% of the caseload. Say that produces 40 swallowing evaluations a month: 34 bedside at $84.84 and 6 videofluoroscopic at $91.52, for $2,884.56 and $549.12, or $3,433.68 in evaluation revenue before any treatment.

Now apply the denial pattern. At a 12% first-pass denial rate on those claims, $412.04 a month goes out unpaid. If 19% of denied claims are never reworked, which is what we find in the average practice we review, $78.29 a month is simply abandoned. That is $939 a year from evaluation codes alone, in a practice where the fix is a modifier rule and a rework queue rather than more patients.

The larger number is upstream. If that same practice is leaving instrumental studies unbilled because the clinician performed the exam and the claim went out as a bedside code, each instance is a $114.90 difference between 92610 and 92612 before the facility question is even raised. Our medical coding team finds this pattern most often in practices that added instrumental capability recently and never updated their charge master.

What are the most common mistakes?

• Billing 74230 as a speech-language pathology practice. It belongs to the radiologist or the facility.
• Billing an interpretation-only code when the clinician performed the study, or billing both the complete and interpretation-only code for one exam.
• Omitting GN on Medicare Part B claims, then appealing on medical necessity when the denial was a modifier problem.
• Treating 92610 as timed and attempting multiple units for a long evaluation. The Medically Unlikely Edit is 1.
• Using modifier 59 reflexively on every same-day pair rather than checking which edits are bypassable. On non-bypassable edits it does nothing except create an audit pattern.
• Missing the KX modifier once the patient passes the $2,480 combined threshold, which denies the claim outright. Our plan of care certification guide covers the related certification timing.
• Letting a bedside evaluation sit as the only exam of record when the clinical question needed instrumentation, which weakens every treatment claim that follows it.

Most of these are caught at the scrub stage rather than on appeal. A full-service billing setup that encodes the pair edits and the GN rule before submission removes the majority of the denial volume shown above, and a working denials and AR recovery queue catches what gets through. Practices comparing vendors can start with our guide to choosing a medical billing company, or send us an ageing report through a free billing review.

How do the swallowing evaluation codes compare side by side?

The quickest way to pick the right code is to answer two questions: which exam was performed, and did the same clinician perform and interpret it. Everything else follows.

On same-day pairing: 92610 against 92611, and 92610 or 92611 against any of 92612 through 92617, are bypassable edits that accept modifier 59. A complete endoscopic code against its own interpretation-only code is not bypassable. 92610 and 92526 carry no edit against each other in either direction, so evaluation and treatment on one date is a medical necessity and documentation question rather than a bundling question, and payer policy decides it.

Outpatient speech therapy clinics

Most dysphagia volume here is 92610 and 92526, both untimed and both capped at one unit a day. The recurring revenue problem is not coding the evaluation, it is the therapy threshold: once combined physical therapy and speech-language pathology spending passes $2,480, every claim without KX denies. Clinics that added endoscopic capability also need their charge master updated, because 92612 pays $199.74 against $84.84 for a bedside exam. See our speech therapy billing page for the wider code set.

Pediatric feeding programs

92610 remains the evaluation code for pediatric feeding, and 92526 the treatment code, but the diagnosis pairing drives the denial rate. The pediatric feeding disorder codes introduced in October 2021 distinguish acute from chronic presentations, and an unspecified code submitted alone is the most common rejection we see on these claims. Caregiver training delivered without the patient present belongs to the 97550 family, not to 92526. Our pediatric billing page covers the broader Medicaid rules.

Hospitals and acute care

This is where the two-biller split on a modified barium swallow actually bites, because the speech-language pathology department and radiology submit separately and the coordination often fails. Instrumental access is better here, which is why instrumental follow-through runs far higher than in other settings. Watch the professional and technical component handling on 74230, which is a radiology question rather than a therapy one. See hospital billing.

Skilled nursing facilities

Part A consolidated billing absorbs therapy services into the facility payment, so the question is usually which services fall inside the stay rather than which code to submit. For Part B residents the outpatient rules apply in full, including the threshold and GN. Repeat bedside evaluations without a documented clinical question are the pattern most likely to draw review. See skilled nursing billing.

Physical therapy practices adding speech services

The habit that causes trouble is unit thinking. Physical therapy runs on timed codes and the 8-minute rule, and clinicians moving between disciplines try to apply the same logic to 92610 and 92526, which are untimed and capped at one unit. The therapy threshold is also shared between the two disciplines rather than separate. Our 8-minute rule guide explains where that boundary sits.