Everything a Speech-Language Pathology or Audiology Practice Needs

To practice, a speech-language pathologist or audiologist needs a license, or a compact privilege, in the state where the patient is located during the visit. State requirements, fees and continuing education rules vary, so each new state is its own application with its own verifications.

The Audiology and Speech-Language Pathology Interstate Compact lets audiologists and speech-language pathologists who are licensed in good standing in a member state practice in other member states through a compact privilege, which is treated as equivalent to a license. The compact covers telehealth as well as in-person care, and practice is considered to take place in the state where the patient or client is located during the encounter. Member states set their own privilege fees and jurisprudence requirements. The compact's current status is shown below.

We work out which states need a full license and which can be covered by a privilege, prepare each application, and keep every license and privilege renewed on time.

ASHA's Certificate of Clinical Competence and a state license are two separate processes. ASHA certification is a national credential; licensure is set and regulated by each state. They ask for many of the same documents, but holding one does not give you the other, and a state license is what allows you to practice in that state.

Because so much paperwork overlaps, we keep one record of your education, clinical fellowship, exam results and work history and reuse it for every state application, every payer application and your CAQH profile. That way an update made once reaches every place it needs to go.

Speech-language pathologists in private practice enroll with Medicare to bill outpatient therapy, and audiologists enroll to bill audiology services under their own Medicare benefit. Both also need separate contracts with Medicaid, Medicaid managed care, Medicare Advantage and commercial plans, most of which rely on a complete, attested CAQH ProView profile.

Neither profession can opt out of Medicare. CMS lists qualified speech-language pathologists and qualified audiologists among the professionals who are not eligible to opt out, which shapes how a cash-pay or out-of-network practice can handle Medicare patients.

Medicare treats speech-language pathology as outpatient therapy. Every line carries the GN modifier, services are furnished under a plan of care certified by a physician or nonphysician practitioner, and the initial certification is timely when it is signed within 30 days of the first treatment, including the evaluation. Since 2025, a signed and dated order or referral on file can stand in for that signature, as long as you document sending the plan to the practitioner within 30 days of the evaluation.

Speech-language pathology shares a combined yearly Medicare threshold with physical therapy; this year's amounts are in the note at the end of this section. Claims above the threshold need the KX modifier, which attests that the services are medically necessary and supported by your documentation, and claims without it are denied. A separate, higher threshold can lead to targeted medical review. Because the threshold is shared, a patient who has already had physical therapy this year may reach it sooner than you expect, so we check before the first visit.

Some speech-language pathology codes are untimed. Medicare's own example is the evaluation code 92521, which is billed as one unit per day no matter how many minutes it takes. Where a timed 15-minute code is used, Medicare's 8-minute counting rules apply, so we check each code's unit rules against the note.

Medicare covers audiology as diagnostic testing, paid under the physician fee schedule. Audiologists bill the tests they personally furnish. Treatment services, such as auditory rehabilitation, are not covered under the audiology benefit, and hearing aids and examinations for prescribing, fitting or changing hearing aids are excluded from Medicare coverage altogether. Cochlear and other implants that replace the function of the ear are a separate case, covered as prosthetic devices.

A physician's order is generally required. Since January 1, 2023, a patient may see an audiologist without an order once every 12 months for certain diagnostic tests for non-acute hearing conditions, billed with the AB modifier. Tests for disequilibrium or balance are not part of that exception, and when a patient arrives with an order, the exception is not used.

Commercial and Medicare Advantage plans often treat hearing aids and hearing exams very differently from Original Medicare, so we verify each patient's benefits before the visit and separate covered testing from self-pay hearing aid services on the claim and the patient's statement.

Speech therapy and hearing services for children are often paid by Medicaid. Most Medicaid beneficiaries under age 21 are entitled to the Early and Periodic Screening, Diagnostic and Treatment benefit, which covers services needed to correct or ameliorate their conditions, and each state and managed care plan sets its own authorization rules on top of it.

Schools can bill Medicaid for covered services as well. CMS guidance says school-based services must be furnished by a Medicaid-participating provider who meets the qualifications for the benefit, and that providers of speech therapy and audiology must meet the federal requirements in 42 CFR 440.110. For services in a child's IEP or IFSP, Medicaid pays first and recovers from other insurers later; for other services, the child's other insurance is generally billed first. CMS's own example is an enrolled audiologist who comes into a school to provide a hearing assessment.

Opening a speech-language pathology or audiology practice is a chain of steps that depend on each other: the entity before the tax ID, the tax ID and organizational NPI before Medicare and Medicaid enrollment, and enrollment before the first claim can be paid. Payer applications take the longest, so we start them as soon as the practice has the identifiers they ask for, and we set up your EHR, scheduling, payments and HIPAA program while they are pending.

If you are adding audiology to a speech practice, a pediatric program, teletherapy or a second state, we work out which licenses, enrollments and payer contracts each addition needs before you commit to a start date, so new clinicians can see patients and bill from their first week.

Medicare reviews therapy and audiology claims against the record: the order or certified plan, the evaluation, daily notes and progress reports for speech therapy, and the order and results for audiology tests. We check documentation against each claim before it goes out, with extra care on KX-modified claims and AB-modified tests.

Your practice also stores recordings, test results and teletherapy sessions that are protected health information. We run your HIPAA security risk assessment, write your policies, train your staff and collect business associate agreements from every vendor that handles patient data, then repeat the assessment every year.