92507 with North Carolina Medicaid: what the policy says
The short answerYes, with prior approval. NC Medicaid pays 92507 as 1 unit per event and allows telehealth. Children under 21 get speech visits by severity, from 6 to 26 for mild up to 52 for severe per authorization period.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · North Carolina. Public policy, not the member's benefits.
North Carolina Medicaid
NC Medicaid Outpatient Specialized Therapy Clinical Coverage Policy 10A · North Carolina
| 92507 | Listed (1 unit = 1 event; telehealth yes) [1] |
|---|---|
| 92508 | Listed (group; telehealth no) [1] |
| 92521 | Listed (evaluation; telehealth yes) [1] |
| 92522 | Listed (evaluation; telehealth yes) [1] |
| 92523 | Listed (evaluation; telehealth yes) [1] |
| 92524 | Listed (evaluation; telehealth yes) [1] |
| 92526 | Listed (telehealth yes for oral motor only) [1] |
| 97165 | Listed (oT evaluation; telehealth yes) [1] |
| 97166 | Listed (oT evaluation; telehealth yes) [1] |
| 97167 | Listed (oT evaluation; telehealth yes) [1] |
| 97168 | Listed (oT re-evaluation; telehealth yes) [1] |
| 97530 | Listed (1 unit = 15 minutes; telehealth yes) [1] |
| 97535 | Listed (1 unit = 15 minutes; telehealth yes) [1] |
| Where it applies | Evaluation and re-evaluation reports are required; treatment plans must be reviewed and renewed or revised at least every six calendar months, and an annual re-evaluation is required for continued treatment. [1] |
| Telehealth rules | Telehealth needs informed consent and must not be used solely for therapist convenience. Telehealth claims carry modifier GT. [1] |
| Visit limits | Under 21, speech-language therapy is limited by severity: mild 6 to 26 visits, moderate up to 46, severe up to 52, within an authorization period of no more than six calendar months. Physical and occupational therapy are limited to the medically necessary visits within a period of up to six months. Age 21 and older: up to 30 treatment visits per calendar year each for OT and PT habilitative (combined), OT and PT rehabilitative (combined), speech habilitative and speech rehabilitative. [1] |
| Prior authorization | Prior approval is required before all treatment services and is obtained from the DHHS utilization review contractor. Prior approval is not required for an evaluation or re-evaluation visit. For a child under 21 the request must show EPSDT criteria are met. [1] |
| Referral | A verbal or written order is required before all outpatient specialized therapy services. A written order is valid up to six months. [1] |
| Who can bill | Billing providers include independent practitioners, children's developmental service agencies, health departments, FQHCs, rural health clinics, hospital outpatient facilities and physician offices employing licensed therapists. A speech-language pathologist in the supervised experience year may work under a licensed SLP, and the supervising SLP bills. [1] |
| Payment | Timed units follow the CMS 8 minute rule: 1 unit is 8 to 22 minutes, 2 units 23 to 37 minutes, and so on. Evaluation and treatment must be on separate claims. [1] |
- NC Medicaid: Outpatient Specialized Therapy Clinical Coverage Policy 10A (amended Oct 1, 2026), checked October 30, 2026
What North Carolina Medicaid's policy says about 92507
92507 is the CPT code for treatment of speech, language, voice, communication and/or auditory processing disorder, individual. At North Carolina Medicaid it is listed: named in the payer's public policy. Each line below is from the cited text:
- Units. 1 unit equals 1 event. (NC Medicaid, checked October 30, 2026)
- How often. Under 21: mild impairment 6 to 26 visits, moderate up to 46, severe up to 52, within an authorization period of no more than six calendar months. Age 21 and older: 30 visits per calendar year for speech habilitative and 30 for speech rehabilitative. (NC Medicaid, checked October 30, 2026)
- Telehealth. 92507 is telehealth eligible; 92508 group is not. (NC Medicaid, checked October 30, 2026)
92507 at other payers
- 92507 with Texas Medicaid (fee-for-service): listed.
- 92507 with New York Medicaid (fee schedule): listed.
The rest of North Carolina Medicaid's pediatric speech and OT rules
The North Carolina Medicaid row has its codes, telehealth rule, limits and authorization, each with its source. Before the claim goes out, compare it with the row in the table above.