After this year, that changes. CPT code 92507 is deleted after December 31, 2026. Starting January 1, 2027, it's replaced by a family of 10 timed codes organized by what you're treating (ASHA, n.d.-a).

Reactions across the field have been mixed, especially around payment for shorter sessions and Medicare's proposed pediatric code. Those concerns are valid, and time will tell how it all plays out. In the meantime, here's how the new codes work and what to check before January.

Why 92507 is being replaced

According to ASHA, CMS and the AMA flagged 92507 in 2024 after Medicare billing for it grew substantially. That triggered a full review through the AMA's CPT and RUC processes. ASHA worked with practicing SLPs and clinical experts to build a replacement, and the AMA CPT Editorial Panel approved the new code family (ASHA, n.d.-a).

ASHA's stated reason is that one broad, untimed code no longer met current CPT standards for specificity (ASHA, n.d.-a). The new codes describe what you treated and how long you treated it.

The 10 new codes

There are five clinical categories. Each one has a base code for the first 30 minutes and an add-on code for each additional 15 minutes (ASHA, n.d.-a, n.d.-b).

Before you load these into your billing system: confirm them against the official 2027 CPT® code set (ASHA, n.d.-b). You may still see placeholder numbers like "92X0X" in older articles; those were used before the AMA published the final codes.

Group treatment: CPT 92508 stays as an untimed code for groups of 2 or more. The difference is that it now stands on its own instead of being tied to the individual code (ASHA, n.d.-a).

Rule #1: Speech + language = the combined code

This rule is easy to miss.

If you treat both speech sound production and language in the same session, you don't bill the speech code plus the language code. You bill the combined code (92660, plus 92661 for extra time). And you never bill the combined code alongside the separate speech or language codes (ASHA, n.d.-a).

Think of a preschooler with a phonological disorder and a language delay, or an adult with dysarthria and aphasia. Both areas in one session means one combined code.

Other categories can be billed on the same day, as long as each service is distinct, medically necessary, and meets its own time requirement. For example, speech sound treatment and voice treatment in one visit can each be reported, if your notes show the goals and the minutes for each (ASHA, n.d.-a).

Rule #2: Count your minutes

92507 was billed once per session, no matter how long it was. The new codes are based on direct, one-on-one patient contact time (ASHA, n.d.-a).

Under the general CPT midpoint rule, here's how time turns into codes (ASHA, n.d.-a):

Two quick examples:

• A 55-minute language session: 92658 ×1 + 92659 ×2. After the first 45 minutes, the last 10 minutes pass the midpoint of the next 15-minute block (ASHA, n.d.-a).
• A 48-minute language session: 92658 ×1 + 92659 ×1. The extra 3 minutes aren't enough for a second add-on (ASHA, n.d.-a).

Another example: say you spend 20 minutes on language and 12 minutes on fluency in the same visit. The language time meets the 16-minute minimum for its base code. The fluency time doesn't. You can't pool minutes across categories, and the same minutes can't count toward two codes.

Heads-up: the midpoint rule is the general CPT convention. Medicare, Medicaid, and private plans can set different time rules, so check each payer's billing policy before you submit (ASHA, n.d.-a).

What this means for your notes

Because the codes are timed, notes need more detail than "session completed." For every session, your documentation should show:

• Which service you provided (fluency, speech sound, language, combined, or voice)

• The goals you addressed

• Your direct treatment minutes for each service you bill Time spent on a different service, or on an untimed service, can't be counted toward these codes (ASHA, n.d.-a). So if your note template doesn't have a place for minutes, now is the time to add one.

Minutes are easiest to record accurately during or right after the session.

Using dictation? If you dictate your SOAP notes with our HIPAA-compliant SLPeaceBot®, just say the service category and your direct minutes as part of your note, for example: "Language treatment, 40 minutes direct; targeted following two-step directions." That way the details billing needs are in the note from the start, and you can check them before you sign.

Medicare, Medicaid, and everyone else

The codes are approved. Medicare payment is not final yet.

• Medicare: CMS proposed payment for all 10 codes in July 2026 and accepted the values ASHA and the RUC recommended. The proposed national Medicare payments for the base codes range from about $50 to $72, and the add-ons from about $23 to $28. These are proposed, Medicare-only, and vary by location. The final rule is expected in early November 2026 (ASHA, 2026a; ASHA, 2026b).

• A proposed pediatric Medicare code, GSLPP: CMS also proposed a separate, untimed Medicare code for pediatric speech-language treatment, valued like 92507. ASHA did not request it and has submitted comments on it. It is a proposal only and may change in the final rule (ASHA, 2026a).

• Medicaid and private insurance: these payers don't have to adopt the new codes or Medicare's rates on January 1. Some may keep accepting 92507 for a while; others may switch right away (ASHA, n.d.-a; ASHA, 2026a).

• Telehealth: ASHA has asked CMS to add the new codes to Medicare's telehealth services list (ASHA, 2026b). If you see Medicare patients by telehealth, check the final rule for this.

Bottom line: keep billing 92507 through December 31, 2026. Don't use the new codes before January 1, 2027. And confirm each payer's start date before you switch (ASHA, n.d.-a).

Free tools to keep track

Nobody wants to do minute math between sessions. We made three free SLPeace® tools so you don't have to remember the thresholds or add things up in your head.

1. Session Time Calculator (Google Sheets)

Type the start and end time for each part of the session and pick the area from a dropdown. The sheet works out the minutes, adds them up by area, and shows what to bill. A Check column next to each line flags problems as you type.

👉 Make your own free copy of the calculator

Here's what it looks like with real sessions:

A language session split into two chunks

The calculator adds the two lines to 39 minutes of language and shows 92658 ×1 + 92659 ×1. Both lines show a green ✓.

A quick fluency sample

You take a 3-minute fluency sample (8:00 to 8:03). The Check column turns pink: "⚠ Fluency: 3 min total. Under 16 = not billed." That's your cue to document it in the note without billing a fluency code.

Articulation and language logged separately

You log 15 minutes of speech sound and 18 minutes of language. Both lines flag: "⚠ Speech sound + language both logged: use combined code."

Change both lines to Speech + language, and the sheet shows 92660 ×1 for 33 minutes.

Typos

The sheet also catches a missing end time, 0 minutes, a line with no area picked, a line over 2 hours, and two lines with overlapping times (the same minutes can't count twice).

Same-minute rule

Some sites and payers don't let one line end and the next start on the same minute. They want 8:00–8:20, then 8:21. If that's your rule, set Same-minute rule to Next line starts 1 min later, and the sheet will flag any line that starts the minute another one ends.

2. Session Time Tracker (printable)

Prefer paper? The tracker has three session blocks per page. Jot each time chunk as you go (like 8:20–8:35, L, following directions), circle the area, and add up the minutes at the end. A chart at the bottom shows what each total bills as, so you don't have to remember the 16, 38, 53, and 68-minute marks.

👉 Download the free tracker (PDF)

3. Cheat sheet and FAQ

Keep the one-page cheat sheet by your desk for the codes and the time chart. The FAQ covers the questions we hear most, like "I did 20 minutes of language and 12 of fluency. Do I get paid for the fluency?"

👉 Download the free cheat sheet (PDF)

The calculator, tracker, and cheat sheet are note-taking aids, not billing or legal advice. Use client initials or an ID rather than full names if your workspace is not secure, and follow your site's HIPAA and record-keeping policies.

From tracker to note: dictate your times and areas into SLPeaceBot®, or snap a photo of your paper tracker (one session at a time) or calculator and let SLPeaceBot® draft the full note. Here's the note it drafted from a photo of the calculator's Example tab. It kept the 39 minutes of language and noted that the 12 minutes of fluency were under the 16-minute minimum and not billed separately.

Your to-do list before January 1

Even if someone else handles billing, your notes are what billing relies on.

• ✅ Learn the five categories and the combined-code rule

• ✅ Start tracking direct minutes now, even though 92507 doesn't require it yet. The habit will be automatic by January

• ✅ Update your note template with a service category and minutes for each code

• ✅ Ask your EHR or billing platform when the new codes will be loaded

• ✅ Ask your billing team or contracting agency which payers are switching on January 1 and which aren't

• ✅ Use ASHA's free transition resources: a template letter to payers, a coding readiness checklist, a payer code tracker, a quick guide, and code-by-code videos (ASHA resources)

• ✅ Attending ASHA Convention? ASHA is holding an in-person CPT code workshop for SLPs on Wednesday, November 18, 2026, 5:30–7:30 p.m. ET, at the JW Marriott Indianapolis (details)

• ✅ Check any contract that names 92507 by number

• ✅ Grab the free tools above: the calculator, the printable tracker, and the cheat sheet

• ✅ Watch for the Medicare final rule in early November

Questions? ASHA's health care education and policy team answers coding questions at reimbursement@asha.org (ASHA, n.d.-a).

Track your minutes, document right away, and check back as payers announce their plans. Because every SLP deserves a little peace.®

This post is general information, not billing or legal advice. Code numbers, payment amounts, and payer rules can change. Always confirm with the official 2027 CPT code set, CMS, and each payer. CPT® is a registered trademark of the American Medical Association. SLPeace®, SLPeaceBot®, Melospeech®, and "Because every SLP deserves a little peace.®" are registered trademarks of Melospeech Inc.

References

American Speech-Language-Hearing Association. (n.d.-a). New speech-language pathology treatment codes replacing 92507. https://www.asha.org/practice/reimbursement/coding/new-speech-language-pathology-treatment-codes-replacing-92507/

American Speech-Language-Hearing Association. (n.d.-b). New codes for 92507. https://www.asha.org/new-codes-for-92507

American Speech-Language-Hearing Association. (2026a, July 15). CMS proposes Medicare payment for new speech-language pathology treatment codes. https://www.asha.org/news/2026/cms-proposes-medicare-payment-for-new-speech-language-pathology-treatment-codes/

American Speech-Language-Hearing Association. (2026b, July 24). 2027 Medicare Part B proposed rule: Coding, payment, and policy analysis. https://www.asha.org/news/2026/2027-medicare-part-b-proposed-rule-coding-payment-and-policy-analysis/

You already have your handy dandy articulation screener from our first post. But you need to screen grammar too, and this little one is rumored to be very shy. You wish you had a brief grammatical morpheme screener you could use to document your concerns.

Well, here it is.

👉 Download the free Brief Grammatical Morpheme Screener (PDF)

👉 Download the picture cards with prompts (PDF): the same 42 cards with each prompt printed small under the picture (never the answer), so you don't have to flip back to the script.

Where this screener came from

A few years back, I ran the MTSS program at a virtual school site. I was tasked with screening every new referral first, then deciding on one of two paths: refer the student for a full evaluation, or start them in MTSS.

MTSS stands for Multi-Tiered System of Supports. It's a school-wide framework that matches the level of support to each student's needs, in layers:

• Tier 1: Strong instruction for every student in the general education classroom
• Tier 2: Targeted, small-group support for students who need a little more
• Tier 3: Intensive, individualized support for students who need the most help

Progress data guide every decision about moving a student between tiers. You may also hear the term RTI (Response to Intervention), a closely related framework that often works inside MTSS.

With referrals coming in constantly, I needed a protocol that let me score everything the same way every time, so my screenings were quick, efficient, and reliable. Every screening ended with a decision I could explain and defend. This screener is built on the same idea, and it will help you do the same.

Why screen grammatical morphemes?

Grammatical morphemes are the small pieces of language that carry grammar: the -ing in running, the -s in cats, the -ed in jumped, and little words like is, the, and a.

Brown (1973) described 14 grammatical morphemes that children acquire in a predictable order, roughly between ages 2 and 4. Because the order is so consistent, these morphemes give you a quick window into whether a child's grammar is developing on schedule.

Why picture probes instead of only a language sample?

A language sample shows you what a child actually uses in conversation, and it's still the gold standard. But in a screening, it has three problems:

1. You may never hear the target morpheme. A child can talk for 50 utterances and never need the past tense.
2. It takes time. Collecting and transcribing a good sample is not a 5-minute job.
3. Shy children give you very little. It takes time to build rapport, and a screening is often the first short session. Short or nonexistent answers make a sample hard to interpret.

Probes solve all three. Each picture and prompt creates an obligatory context, a sentence where the morpheme has to appear, so you hear whether the child can produce it. This is the same idea behind Berko's (1958) classic "wug" test.

For example, you show a card with one cat and then two cats and say, "Here is one cat. Here are two ___." The child only needs to say one word: cats. That makes probes much easier for a shy child than open-ended conversation.

The screener still includes an optional language sample and MLU section, because probes show what a child can produce, while a sample shows what they actually use.

What's in the free screener

The 8-page PDF includes:

• A protocol page with administration and scoring rules
• A probe script with the picture, prompt, and target for all 42 items
• A score sheet that walks you through the result for each morpheme
• A summary page for clinical observations, an optional MLU calculation, and your final result
• 42 original picture cards, labeled by number only (for example, 4a) so they don't show the target word

Prefer not to flip back to the script? A separate download has the same cards with each prompt printed in small type under the picture. Most children under 5 can't read, so it won't distract them, and the answer is never shown.

There are 3 probes for each of Brown's 14 morphemes. For plurals, possessives, regular past tense, and 3rd person -s, the three probes cover all three sound forms (/s/, /z/, and /ɪz/), as in cats, dogs, and buses. The /ɪz/ forms often come in last, so this gives you useful detail.

How to give it

Most children finish in about 5 minutes. Show one card at a time and read the prompt exactly as written.

• Don't model the target. Say the prompt, and repeat it once if the child wasn't listening.
• Bare answers don't count when the target is a small word. If you ask "Tell me what he's doing" and the child says "eating," you haven't heard the is. Re-prompt once: "Say the whole thing."
• Full or contracted forms both count in contractible contexts (she is or she's).
• Write down every answer. An unexpected answer is useful clinical information.

How to score it

Mark each item correct, incorrect, or D for a dialect feature (more on that below). A morpheme is solid when the child gets all 3 of 3 probes correct. This is a screening rule, not a mastery rule. Brown defined mastery as correct use in 90% of obligatory contexts in spontaneous speech.

Then, for each morpheme below 3 of 3, compare it to the child's age:

Why the 2-of-3 tier? A child who gets 2 of 3 can produce the morpheme but doesn't use it consistently yet. That's exactly the kind of skill targeted MTSS support can move. As a school SLP, I saw MTSS help many of these kids catch up.

The age ranges are the commonly cited ages of mastery for Brown's morphemes (Brown, 1973; Miller, 1981):

These ages come from a small number of children, so treat them as guides, not cutoffs. The order of acquisition is more reliable than the exact ages.

Screening an older child, like that 2nd grader

Every age range on the list ends by about 50 months (4;2). So for a 2nd grader, every morpheme should already be in place. A morpheme at 2 of 3 points toward MTSS, and a morpheme at 0 or 1 of 3 points toward a full evaluation.

Pay special attention to tense markers: -ed, 3rd person -s, and forms of is and are. School-age children with developmental language disorder (DLD) often keep leaving these out long after their peers have mastered them (Rice et al., 1995).

Older children may find the pictures easy. That's fine. Present it as a quick picture game. The goal is to hear their grammar, not to challenge their vocabulary.

Don't score dialect as disorder

Rule-governed dialect features are not errors. In African American English, for example, these are common and expected:

• Zero copula or auxiliary: She tired, He eating
• Zero 3rd person -s: She run
• Zero possessive -s: the dog bone
• Regularized forms: He have a hat

Mark these D on the score sheet and count them as correct. For children learning English as a second language, compare their answers to what you'd expect given their English exposure, and talk with the family. When you aren't sure what's typical in a child's community, ask a trusted colleague before you score.

From screening to next step

The score sheet leads you to one result:

• Refer for a full speech-language evaluation if any morpheme is at 0 or 1 of 3 past its age range, the error pattern is unusual, or the child is harder to understand than expected for their age.
• MTSS if one or more morphemes are at 2 of 3 past their age range, and none are at 0 or 1. Start targeted support, track progress, and re-screen in 3 to 4 months.
• Monitor if the only misses are on morphemes still within their age range. Re-screen in 3 to 4 months.
• Pass if all morphemes are solid, or the only differences are explained by the child's age, dialect, or language background.

The result is a suggestion. When in doubt, lean toward referring: over-identifying for an evaluation is safer than missing a child who needs one, and your clinical judgment can always override the score.

One important reminder: MTSS and RTI can't be used to delay or deny an evaluation when a disability is suspected (U.S. Department of Education, OSEP, 2011). If your screening raises a real concern, refer.

Screening by video

The screener works through telepractice too.

• Screen-share the picture cards one at a time.
• Ask a facilitator, such as a parent or aide, to keep the child near the microphone.
• If you can't hear an ending clearly, especially final -s or -ed, ask the child to say it again rather than guessing. These small sounds are easy to lose over video.

Get the free screener

👉 Download the free Brief Grammatical Morpheme Screener (PDF)

👉 Download the picture cards with prompts (PDF): the same 42 cards with each prompt printed small under the picture (never the answer), so you don't have to flip back to the script.

👉 Get the auto-scoring score sheet (Google Sheet): enter the child's age and each mark, and it checks every morpheme against the age ranges and suggests Refer, MTSS, Monitor, or Pass.

Pair it with the articulation screener, and you can screen both speech and grammar in one short session. Screen fast, document right away, and leave work at work.

References

Berko, J. (1958). The child's learning of English morphology. Word, 14(2–3), 150–177. https://doi.org/10.1080/00437956.1958.11659661

Brown, R. (1973). A first language: The early stages. Harvard University Press.

Miller, J. F. (1981). Assessing language production in children: Experimental procedures. University Park Press.

Rice, M. L., Wexler, K., & Cleave, P. L. (1995). Specific language impairment as a period of extended optional infinitive. Journal of Speech and Hearing Research, 38(4), 850–863. https://doi.org/10.1044/jshr.3804.850

U.S. Department of Education, Office of Special Education Programs. (2011). A response to intervention (RTI) process cannot be used to delay-deny an evaluation for eligibility under the Individuals with Disabilities Education Act (IDEA) (OSEP Memo 11-07, January 21, 2011). https://sites.ed.gov/idea/idea-files/osep-memo-11-07-response-to-intervention-rti-memo/

At Melospeech®, we use a simple form that one of our SLPAs on our expansion team built for us years ago. We've modified it for you free. It helps do the tracking work for you, and it makes submitting your mileage to your employer or contracting agency that much easier.

Pair it with a visit verification signature (which our cool SLPeace® tool offers, by the way) and you can show you were at each site, while the form pulls the shortest driving distance straight from Google Maps.

We're sharing this resource free in hopes it saves you time the way it saves us. Make a copy and add it to your workflow!

👉 Make your free copy of the SLPeace® Mileage Tracker (Google Sheet)

Why mileage tracking eats your time

Mileage is money you've already earned. But when logging it is a hassle, it gets put off until the end of the pay period. Then you're reconstructing a week of visits from your calendar and guessing at distances. Some clinicians give up and don't claim it at all. When I was a school SLP there were times when I just didn't submit my mileage because I was too busy to keep track.

The fix is to log each drive as you go, in a format that does the math for you.

What the tracker does

You type in where you started and where you went. The sheet does the rest.

A few features we added for you:

• Manual Miles override. If a road closure or detour meant you drove farther than Google's route, type your actual miles. The sheet uses your number instead.

• A Purpose column. An optional way to note what each visit was (session, evaluation, IEP meeting) so every drive has a business reason attached.

• No hardcoded rates. The IRS rate can change, and has changed mid-year before. You enter the current rate on the Calculator tab, using the link to the IRS page, so the math is never out of date.

Set it up once (about 1 minute)

1. Make your copy using the link above.

2. Fill in your name, pay period, and employer at the top of the Mileage Log.

That's it. The Google Maps lookup is already built in, so there's no app to install, no code, and no subscription. If Google ever asks permission to use Google Maps, click Allow. The sheet only looks up driving routes. It does not track your location.

Use it every visit day

• After each drive, add one row: date, start and end client (initials or ID), and both addresses. Adding the purpose is optional, especially if you are only logging visits each time, but can be used if required by your employer.

• Check the miles. If Google's distance doesn't match what you drove, enter your actual miles in Manual Miles.

• At the end of the pay period, you or your employer can open the Calculator tab and enter the current IRS rate. The sheet can then be downloaded or shared with whoever approves your mileage! It can also be stored for future audit.

Tip: Keep the tracker bookmarked on your phone and log each drive before you pull away from the curb. Thirty seconds per stop beats an hour of reconstruction on Friday.

What counts, and what doesn't

Policies vary by employer, so use your employer's rules if they differ. The sample policy on the Policies tab is a starting point you can edit.

Back it up with visit verification

A mileage log shows where you drove. A visit verification signature shows you were actually there. Together, they can make a simple, easy-to-check record for whoever approves your reimbursement, without anyone tracking your phone all day.

Our SLPeace® tool offers visit verification signatures, so each logged drive can line up with a signed visit.

Protect your clients' privacy

A list of client names next to home addresses is sensitive information if not kept securely. In any case, at Melospeech® we like to minimize sensitive data on any form that may be shared with other unrelated parties (e.g., auditors). To keep your log safe:

• Use initials or client ID numbers, instead of full names.

• Keep the sheet in a secure folder or location that only you and your approver can open.

• Follow your employer's HIPAA and FERPA policies for anything that includes client information.

Get the free tracker

👉 Make your free copy of the SLPeace® Mileage Tracker (Google Sheet)

Log as you go, submit on time, and keep the money you've earned. Your time is worth protecting, and so are your miles.

This tracker is a general template, not tax or legal advice. Your employer's policy and a tax professional have the final say on what is reimbursable. Google Maps and Google Sheets are trademarks of Google LLC; this tracker is not affiliated with or endorsed by Google.

Resources

Internal Revenue Service. (n.d.). Standard mileage rates. https://www.irs.gov/tax-professionals/standard-mileage-rates

Internal Revenue Service. (n.d.). Publication 463: Travel, gift, and car expenses. https://www.irs.gov/publications/p463

Back then, our go-to was the CAPE-V. It has since been updated, so this guide walks you through the newest version. It uses a free, open-access form and no special equipment.

Why you need a perceptual voice tool

In home health, mobile outpatient, and telehealth settings, you rarely have acoustic analysis tools like Visi-Pitch or the Computerized Speech Lab (CSL) on hand.

You still need a standardized way to describe voice quality, document baseline severity, and track treatment outcomes.

That's where the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) comes in. It was developed through ASHA's Special Interest Division 3 after a 2002 consensus conference, and it's often considered the gold standard for auditory-perceptual voice evaluation (Kempster et al., 2009; Kempster et al., 2025).

In 2025, the CAPE-V got its first major update: the CAPE-V Revised (CAPE-Vr). It keeps the original's purpose but is simpler to give and score, and it was built with virtual and unrecorded sessions in mind (Kempster et al., 2025). It isn't the version we used in our voice work, but if you're learning the tool now, this is the one to learn.

Note that this is a perceptual evaluation, not a stand-alone diagnostic tool. It should be one part of a full voice assessment, not the only tool you use to decide the nature of a voice disorder (ASHA, 2002/2009).

Get the free form

The CAPE-Vr is open access. Download the printable form here:

👉 Download the CAPE-Vr form (PDF)

Form © 2025 Kempster, Nagle & Solomon, published open access under CC BY 4.0 with their article in the Journal of Voice. Shared unchanged.

📊 Get the free CAPE-Vr Progress Tracker (Google Sheet): our companion log for your ratings. It calculates change from baseline for each attribute and charts progress across sessions. It doesn't replace the official form; rate on the form, then log your numbers here.

📖 For the full instructions and the reasons behind each change, see Table 1 in the open-access CAPE-Vr article.

Printing tip: The rating lines only score correctly if each one is exactly 100 mm. After printing, measure one. If it isn't 100 mm, write the actual length on the form, then divide each measurement by that length and multiply by 100 (Kempster et al., 2025).

Before you start: set up and note your conditions

Seat the client comfortably in a quiet room. Place your microphone or device at a fixed distance from their mouth and record the session (Kempster et al., 2025).

The CAPE-Vr form has a Recording Conditions section. Note:

• whether you recorded or not

• whether the session was in person or virtual

• the room, the device or video platform, and the mouth-to-microphone distance

This is what makes the CAPE-Vr a good fit for home health and telehealth. You don't need lab equipment. You document what you used, so you or another clinician can set it up the same way next time.

The tasks

You can give the three main tasks in any order (Kempster et al., 2025).

1. Sustained vowels

Ask the client to say /ɑ/ ("ah") and /i/ ("ee") in their typical speaking voice, holding each for 3 to 5 seconds.

• One trial of each is enough, as long as it sounds typical of the person's speaking voice.

• Don't model it. Clients tend to copy your pitch and voice quality (Kempster et al., 2025).

2. Sentences

Have the client read each sentence aloud in their typical speaking voice. Each sentence targets a different feature (Kempster et al., 2025):

Print the sentences in a large, easy-to-read font. If the client has trouble reading, you can model each sentence, and check the box on the form to show you did.

Telehealth tip: Screen-share the sentences in large, bold text, one at a time.

3. Extemporaneous speech

Get at least 20 seconds of natural speech with this prompt:

"Tell me about a place you have gone or would like to go."

The old CAPE-V prompt was "Tell me about your voice problem." The change is deliberate: it keeps the sample from revealing the voice concern to whoever rates the recording, and it works for clients with no voice complaint at all (Kempster et al., 2025). Any other prompt that isn't about voice is also acceptable.

Optional: reading passage

If you also use a reading passage, such as the first paragraph of the Rainbow Passage, note it on the form (Kempster et al., 2025).

How to score

Rate from the recording

Ratings are meant to be made from the recording. If you rate live instead, mark that on the form. Listen as many times as you need, and note:

• how many times you played the samples

• headphones or speakers

• whether you used reference voice samples as anchors

• who rated it and when

(Kempster et al., 2025)

Four attributes on the 100 mm lines

(Kempster et al., 2025)

"Normal" is printed above the left end of the lines and "Extreme" above the right. Make a small tick mark anywhere on each line. Then measure in millimeters from the left end to your mark and write the number in the blank, for example, Roughness 56/100.

There's one blank line if you want to rate another attribute.

Everything else: circle what you hear

These are rated with categories, not lines (Kempster et al., 2025):

Finish with your Overall Impression: the overall severity in a few words, plus the voice's most prominent features.

Getting reliable ratings without a lab

Rater agreement on perceptual voice scales has always varied widely (ASHA, 2002/2009). Three habits help:

• Keep your setup the same. Use the same device, room, and mouth-to-microphone distance at every visit when you can, so recordings are comparable over time (Kempster et al., 2025).

• Compare to baseline. At follow-up visits, listen to the earlier recording next to the new one, with the earlier form in front of you (ASHA, 2002/2009).

• Practical tip for video calls: if your platform has noise suppression or "voice enhancement" settings, consider turning them off. They're designed to clean up audio, which may soften the very qualities you're rating.

Still seeing the original CAPE-V?

You will. It's what most grad programs taught, what most textbooks print, and what's in a lot of existing client files. Here's what's different in the original (ASHA, 2002/2009; Kempster et al., 2025):

• Three vowel trials instead of one

• Different sentences b, d, and f: "How hard did he hit him?", "We eat eggs every Easter," and "Peter will keep at the peak"

• The prompt "Tell me about your voice problem"

• Pitch and loudness rated on 100 mm lines, with the direction written in

• "MI / MO / SE" severity labels under each line. These were dropped partly because two versions of the form placed them in different spots.

• A C (consistent) or I (intermittent) mark next to every scale, instead of one Inconsistencies section

Whichever version you use, use the same one every time with the same client. Switching versions makes progress hard to compare. If a client's baseline was done on the original CAPE-V, keep re-rating them on the original.

Quick-reference checklist

References

American Speech-Language-Hearing Association. (2002/2009). Consensus auditory-perceptual evaluation of voice (CAPE-V). ASHA Special Interest Group 3, Voice and Voice Disorders. https://resources.finalsite.net/images/v1693231587/resanet/djvm3pfoizvmmqaydzx9/cape-v-procedures-and-form.pdf

Kempster, G. B., Gerratt, B. R., Verdolini Abbott, K., Barkmeier-Kraemer, J., & Hillman, R. E. (2009). Consensus auditory-perceptual evaluation of voice: Development of a standardized clinical protocol. American Journal of Speech-Language Pathology, 18(2), 124–132. https://doi.org/10.1044/1058-0360(2008/08-0017)

Kempster, G. B., Nagle, K. F., & Solomon, N. P. (2025). Development and rationale for the Consensus Auditory-Perceptual Evaluation of Voice–Revised (CAPE-Vr). Journal of Voice. Advance online publication. https://doi.org/10.1016/j.jvoice.2025.01.022

Working off the clock shrinks your paycheck, no matter how big it is. Every hour of unpaid work lowers your real hourly rate. So how do you make sure you finish your work at work?

The answer is not to work harder. Instead, make every routine task faster and more efficient. Screening is one of the most common routine tasks, and it shows up in every setting, especially in schools. Many of those referrals arrive with the same note: "Child sounds different."

An articulation screener you can finish in 5 to 7 minutes is priceless. Here's how to build one, and what the research says about doing it well.

The math of a faster screener

Say you screen 10 students a month, and each screening takes you 20 minutes from pulling the student to filing the result. If you cut that to 7 minutes, you get back more than two hours every month. Over a school year, that's about 20 hours, or close to three full workdays you're no longer giving away.

A screener is not an evaluation, so it shouldn't take as long as one. Its only job is to sort students: Does this child need a closer look, or not?

1. Rapid sound sampling with single words

The core of a fast screener is a single-word picture-naming protocol. You show a picture, the child names it, and you score each target sound. Single words let you sample target consonants in clear, standard units without tiring out young children or eating up session time.

The free screener that goes with this post uses 15 carefully chosen words. Together they sample every English consonant class:

In 5 to 7 minutes, you can spot the four main error types seen in speech sound disorders: omissions, substitutions, additions, and distortions (ASHA, n.d.).

Read errors against age, not just the percentage

This is where new SLPs most often go wrong. A percentage score alone can mislead you, because some sounds develop much later than others.

A large review of U.S. English-speaking children found that most consonants are acquired by about age 5. A few sounds, including /ɹ/, /ð/, /ʒ/, and /θ/, come in later, around 5 to 6 and beyond (Crowe & McLeod, 2020).

So picture a 4-year-old who says "wing" for ring and "fum" for thumb. Those errors are developmentally expected. But the same child saying "tup" for cup or leaving off final sounds is a different story.

The rule: before you decide on a result, check whether each error is still within the typical range for the child's age.

2. Separate true disorders from dialects and accents

When a referral says a child "sounds different," the most important question to ask is: Different compared with whom?

Dialects are rule-governed language systems, and accents are systematic patterns in how speech is produced. Neither one is a speech sound disorder, and a disorder can't be identified by comparing a child to Mainstream American English (ASHA, n.d.).

A good screener asks whether the child's speech matches what is expected in their own linguistic community. Some common examples that are not errors:

• Final consonant cluster reduction in African American English, such as "tes'" for test

• /f/ for /θ/ at the end of words in African American English, such as "baf" for bath

• /tʃ/ and /ʃ/ used interchangeably by children whose first language is Spanish, such as "chew" for shoe

If you score these as errors, you overidentify students, fill your caseload with children who don't need you, and spend time you don't have on evaluations that shouldn't happen. When you aren't sure what a child's community dialect sounds like, talk with the family or a trusted colleague before you score.

3. Listen to how the child talks, not just the sounds

Sometimes "sounds different" has nothing to do with which sounds a child gets right. It's about the rate and ease of their speech.

A large study of 570 typically developing children aged 2;6 to 9;11 (Mahr et al., 2021) found two things every screening SLP should know:

1. Typical speakers vary a lot. Differences in articulation rate were bigger within a single age than between ages. The gap between slower and faster typical speakers of the same age matched roughly five years of developmental change.

2. There is a floor. On repeated sentences, typically developing children produced at least about 2.5 syllables per second by age 4 and about 3 syllables per second by age 10 (5th-percentile values). The authors note that children well below these values may have an underlying disorder.

You won't measure syllables per second in a 5-minute screener, because those benchmarks come from acoustic analysis. Still, the takeaway is practical. If a child's speech sounds noticeably slow, effortful, or labored compared with their peers, write it down. That's a reason to look closer, even when every sound on your word list is correct. And because typical rate varies so widely, a child who just talks a little slower than classmates is not, on that basis alone, a concern.

4. Clear outcomes and next steps

A streamlined screener gives you a result you can act on right away. Based on the child's performance across the sound classes, choose one of four paths:

• Pass: Speech sound production is age-appropriate for the child's linguistic community.

• Monitor: Errors are present but still within the typical developmental window. Re-screen after a set period, such as 3 to 4 months.

• RTI / MTSS: Provide targeted general education support through a Multi-Tiered System of Supports.

• Full comprehensive evaluation: Refer for a full assessment of speech, language, and hearing.

One important reminder: RTI and MTSS should not be used to delay or deny an evaluation when a disability is suspected (U.S. Department of Education, OSEP, 2011). If your screening raises real concern, refer.

The free screener that goes with this post makes that decision simple. Instead of a percentage cutoff, you compare each error to the age at which 90% of children have mastered that sound:

• Refer if the child misses any sound they should already have for their age, shows an unusual error pattern, or is harder to understand than expected for their age.

• Monitor if the only errors are on sounds the child is still in the age range to learn.

• Pass if there are no errors, or the only errors are on sounds the child is too young to have mastered yet.

Your clinical judgment, along with the child's dialect and language background, always comes first.

5. It works in person or through telepractice

Whether you work in a school building or deliver services virtually, single-word screeners adapt well to telepractice. A systematic review found that telepractice and in-person assessment gave comparable results for speech samples and intelligibility ratings (Masso & Thomas, 2022).

The same review found weaker agreement on oral-motor tasks and on identifying some consonant errors. To get the most from a virtual screening:

• Use good lighting so you can see the child's mouth

• Use a quality microphone on the child's end

• Have a facilitator (a parent or aide) help position the camera

• If a sound is unclear over video, mark it for a follow-up instead of guessing

Get the free screener

To make all of this faster, we built a free, printable English Phoneme Speech Sound Screener. It includes:

• A 15-word screening protocol with administration guidelines

• A phoneme summary with the age by which 90% of children master each sound (Crowe & McLeod, 2020)

• A score sheet that walks you through the Pass, Monitor, or Refer decision

• Sections for clinical observations, including intelligibility, stimulability, and dialect or second-language factors

• Picture cue cards for all 15 words

👉 Download the free articulation screener (PDF)

👉 Get the auto-scoring score sheet: the same score sheet as a Google Sheet. It totals your errors and suggests Pass, Monitor, or Refer for you. Click "Make a copy."

Screen fast, document right away, and finish your paperwork before the last bell. Your time is worth protecting, and that habit starts with the routine tasks.

References

American Speech-Language-Hearing Association. (n.d.). Speech sound disorders: Articulation and phonology [Practice portal]. https://www.asha.org/practice-portal/clinical-topics/articulation-and-phonology/

Crowe, K., & McLeod, S. (2020). Children's English consonant acquisition in the United States: A review. American Journal of Speech-Language Pathology, 29(4), 2155–2169. https://doi.org/10.1044/2020_AJSLP-19-00168

Mahr, T. J., Soriano, J. U., Rathouz, P. J., & Hustad, K. C. (2021). Speech development between 30 and 119 months in typical children II: Articulation rate growth curves. Journal of Speech, Language, and Hearing Research, 64, 4057–4070. https://doi.org/10.1044/2021_JSLHR-21-00206

Masso, S., & Thomas, D. (2022). Assessment of speech sound disorders in children: Considerations for telepractice. EBP Briefs, 15(2), 1–6. https://www.pearsonassessments.com/content/dam/school/global/clinical/us/assets/ebp-briefs/ebp-v15a2.pdf

U.S. Department of Education, Office of Special Education Programs. (2011). A response to intervention (RTI) process cannot be used to delay-deny an evaluation for eligibility under the Individuals with Disabilities Education Act (IDEA) (OSEP Memo 11-07, January 21, 2011). https://sites.ed.gov/idea/idea-files/osep-memo-11-07-response-to-intervention-rti-memo/