The History of SLP and Why CPT 92507 Matters
If you’re an SLP feeling frustrated about reimbursement changes, CPT codes, or productivity pressures — this post is for you.
Because 92507 didn’t just appear out of nowhere. Our field has always been shaped by war, gender norms, policy, and money. And most of us were never taught that.
Let’s rewind.
Before Licensure: When Anyone Could “Fix Speech”
In the late 1800s and early 1900s, there were:
No state licenses
No standardized graduate programs
No governing boards
No national credentials
If you claimed you could correct speech, you could practice.
Speech services were often provided by:
Teachers
Clergy
Orators
Elocution coaches
Some programs were even sold by mail. Speech correction wasn’t yet medical. It was part performance, part education, part social refinement.
And yes — there were plenty of unregulated “experts.”
The Elocution Era: Speech as Social Status
Early speech correction was heavily influenced by the elocution movement. Speech wasn’t just communication — it was seen as a marker of intelligence, morality, and class.
“Correct speech” often meant:
White
Middle or upper class
Regionally neutral
Those biases shaped early intervention philosophies.
This is an important truth: our field has never existed outside of social context.
World War I Changed Everything
During World War I, thousands of soldiers returned with:
Brain injuries
Aphasia
Dysarthria
“Shell shock”
Physicians suddenly needed specialists to address communication impairments. Speech correctionists were brought into military hospitals.
This was a turning point. Our profession shifted from: Speech refinement → Medical rehabilitation. War anchored us to medicine.
The Creation of ASHA
In 1925, 25 speech scientists and teachers formed what was originally called the American Academy of Speech Correction. That organization would eventually become the American Speech-Language-Hearing Association (ASHA).
Two influential early figures:
Smiley Blanton
A speech pathologist who collaborated with psychiatrists and helped legitimize stuttering treatment within medical settings.
Lee Edward Travis
Often referred to as a foundational figure in speech pathology, heavily influenced by neurology and early brain-based models.
Why was ASHA formed?
To:
Establish scientific legitimacy
Standardize training
Differentiate qualified professionals from “quacks”
Protect the profession
Credentialing came before widespread licensure.
State Licensure Came Much Later
Here’s something most SLPs don’t know:
Even after ASHA was formed in 1925, most states did not immediately require licensure. Licensing laws were rolled out gradually between the 1950s and 1990s.
For decades, professional identity was largely self-regulated through ASHA’s Certificate of Clinical Competence (CCC). Legal protection of the title came much later.
That means our professional structure evolved in layers:
Informal practice
Professional association
Credentialing
State licensure
Insurance integration
Each layer changed how we practiced.
Medicare, Medicaid & the Documentation Shift
In 1965, the passage of:
Medicare
Medicaid
Fundamentally altered healthcare delivery in the United States.
Speech therapy now had to:
Demonstrate medical necessity
Document measurable progress
Fit into reimbursement structures
Therapy began to shift from:
Relational and educational models → Medical documentation and billing models.
Reimbursement began shaping practice.
The Rise of CPT Coding & 92507
The Current Procedural Terminology (CPT), developed by the American Medical Association in the 1960s and expanded in later decades, standardized how medical procedures were reported and billed.
For speech-language pathologists, one code became central:
92507
Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual.
One code.
Covering:
Articulation therapy
Aphasia treatment
Language delay
Voice therapy
Pragmatics
Cognitive-communication
A catch-all code for an incredibly diverse scope of practice.
When reimbursement changes impact 92507, they don’t affect one niche.
They affect almost all outpatient and clinic-based SLP services.
Gender, Pay & Professional Value
Another piece rarely discussed: Speech-language pathology has long been a female-dominated profession.
Historically, professions dominated by women have:
Lower average reimbursement
Lower pay scales
Reduced perceived medical authority
This isn’t coincidence. It’s part of broader healthcare economics and social structure.
Professional valuation doesn’t happen in a vacuum.
Why This History Matters Now
When reimbursement shifts. When codes change. When states debate eliminating or reducing coverage. When productivity expectations rise.
It’s not random.
Our field has always been shaped by:
War
Policy
Economics
Gender dynamics
Insurance systems
92507 isn’t just a billing number. It represents how the healthcare system values communication. And understanding that history changes how we advocate.
The Bigger Picture
We started as elocution teachers. We became medical rehabilitation providers because of war. We formed a professional association to protect our credibility. We gained licensure decades later. We adapted to Medicare, Medicaid, and CPT coding.
And now we are navigating another shift.
The question isn’t:
“Why is this happening?”
The better question is:
“How do we lead through it?”
Because our profession has always evolved. The difference now?
We’re aware of the systems shaping us.
And awareness creates leverage.
References
American Speech-Language-Hearing Association. (n.d.). ASHA history and milestones. American Speech-Language-Hearing Association.
(Archival materials outlining the founding in 1925 as the American Academy of Speech Correction and the evolution of certification and licensure.)
American Medical Association. (n.d.). History of Current Procedural Terminology (CPT). American Medical Association.
(Development of the Current Procedural Terminology system and expansion into standardized billing.)
Blanton, S. (1930s–1940s publications). Early writings on stuttering and speech correction within medical contexts.
Travis, L. E. (1931). Speech Pathology: A Dynamic Neurological Approach.
(Foundational text emphasizing neurological underpinnings of speech disorders.)
U.S. Social Security Administration. (1965). Amendments establishing Medicare and Medicaid under the Social Security Act.
(Creation of Medicare and Medicaid and their impact on medical reimbursement structures.)
Bentley, R. J. (2009). A Short History of Speech Pathology. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations.
Duchan, J. F. (n.d.). The History of Speech-Language Pathology.
(Scholarly overview of professionalization, early training programs, and social influences.)
American Speech-Language-Hearing Association. (n.d.). State licensure requirements timeline.
(Documentation of staggered licensure adoption across states from mid-20th century onward.)
Disclaimer:
This post is intended for educational and professional awareness purposes. Readers are encouraged to review primary sources and ASHA archival materials for deeper study.
