Telepractice Voice Evaluation: Smartphone Acoustic Analysis, Remote CAPE-V and CPT 92524 Documentation
Key takeaways
- Smartphone recordings are reliable for tracking the same patient over time, when you keep the phone, app and distance the same.
- Absolute values can shift between phones and lab microphones, especially shimmer, noise ratios and AVQI. Compare patients with their own baseline.
- F0 and CPPS are the most robust measures from phone recordings in recent studies.
- The CAPE-V works well remotely. The 2025 revision (CAPE-Vr) recommends rating from recordings rather than live voice.
- CPT 92524 covers behavioral and qualitative voice and resonance evaluation. Medicare telehealth for SLPs is extended through December 31, 2027.
What is a telepractice voice evaluation?
A telepractice voice evaluation is a voice assessment that a speech-language pathologist (SLP) completes remotely. It combines a video interview, patient-reported questionnaires, perceptual rating of recorded voice samples (such as the CAPE-V) and acoustic analysis of recordings the patient makes on their own phone or computer.
Done well, it gives you the same core information as an in-clinic evaluation, except laryngeal imaging. It also adds something clinics rarely get: recordings from the patient’s real environment, repeated as often as you need.
Is smartphone acoustic voice analysis valid? What the research says
Short answer: yes for tracking change in one patient, with care for comparing absolute values. Here is what key studies found.
| Study | Design | Key finding |
|---|---|---|
| Grillo et al., 2016 Int J Telerehabil | 10 healthy adults; 2 iPhones and a Samsung vs head-mounted mic; Praat, MDVP and ADSV | “No significant within-subject variability across devices and software.” Means of some measures (e.g., AVQI, NHR, CPP) differed from the head mic. |
| Journal of Voice, 2021 PMID 33676807 | 183 people (86 normal, 97 voice disorders); smartphone vs oral studio mic, with added ambient noise | AVQI showed acceptable agreement, with no significant systematic differences. |
| Maskeliūnas, Uloza et al., 2023 Applied Sciences | Adults with healthy and disordered voices; several current iPhone and Android models vs studio mic | Strong correlation of AVQI between smartphones and studio mic; all devices met an AUC threshold of 0.8 for detecting dysphonia. |
| Nakum & Joshi, 2023 Int J Telerehabil | 20 adults (10 typical, 10 dysphonic); home phone recordings vs lab mic | F0 and CPPS did not differ significantly; HNR and AVQI did, which the authors linked to home background noise. CAPE-V ratings did not differ. |
Which measures can you trust from a phone?
| Measure | Phone robustness | How to use it remotely |
|---|---|---|
| F0 (pitch) | High | Reliable across devices. |
| CPP / CPPS | Good | Strong primary measure for remote tracking. See CPP vs CPPS. |
| AVQI | Good for trends | Compare with the patient’s own baseline; noise can raise the score. See our AVQI guide. |
| Shimmer, HNR/NHR | Sensitive | Most affected by background noise and device; interpret with care. |
| Jitter | Sensitive | Device effects reported in some groups; use as supporting data only. |
The rule that makes remote acoustics work: same phone, same app, same distance, same quiet room, every session. Grillo et al. (2016) recommend using “the same phone and the same app within each individual” with a fixed mouth-to-microphone distance.
Smartphone recording protocol for remote voice analysis
- Use one device per patient. Note the phone model in the chart and reuse it.
- Fix the distance. Studies used 4 cm to 30 cm. Pick one and keep it; a phone stand helps.
- Quiet room. Turn off fans, TV and air conditioning; close windows and doors.
- No speakerphone or video-call audio. Call apps compress and filter sound. Record directly on the device instead.
- Uncompressed audio where possible. Studies recorded WAV at 44.1 kHz.
- Same time of day for follow-ups, since voice changes across the day.
- Do a sound check before the real tasks and repeat if you hear clipping or noise.
Phonalyze records straight in the patient’s browser, no app and no video-call audio.
Try free for 30 daysHow to give the CAPE-V remotely (and what changed in the CAPE-Vr)
The CAPE-V (Consensus Auditory-Perceptual Evaluation of Voice) is a standard protocol for rating voice quality from three tasks: sustained vowels, six set sentences and connected speech. It was published by Kempster and colleagues in 2009 and revised in 2025 as the CAPE-Vr.
The three CAPE-V tasks
- Sustained vowels: /ɑ/ and /i/, about 3 to 5 seconds each.
- Six sentences that stress different voice features (listed below).
- Connected speech: at least 20 seconds of natural conversation.
CAPE-Vr sentences (2025)
- The blue spot is on the key again.Unchanged
- He helped her hurry home.Replaces “How hard did he hit him?”
- We were away a year ago.Unchanged
- I eat eggs every evening.Replaces “We eat eggs every Easter.”
- My mama makes lemon muffins.Unchanged
- Papa took a piece of the cake.Replaces “Peter will keep at the peak.”
What changed in the CAPE-Vr
| Area | CAPE-V (2009) | CAPE-Vr (2025) |
|---|---|---|
| Vowels | Three repetitions each of /a/ and /i/ | One production each of /ɑ/ and /i/; modeling discouraged |
| Sentences | Original six | Three sentences replaced (above) |
| Conversation prompt | “Tell me about your voice problem.” | “Tell me about a place you have gone or would like to go.” |
| Rating lines | 100-mm lines with mild/moderate/severe markers | Markers removed; “normal” and “extreme” at the ends |
| Pitch and loudness | Visual analog scales | Categorical choices; resonance and nasality added |
| Rating source | Live or recorded | Rate from audio recordings rather than live voice |
Remote CAPE-V tips
- Record, then rate. The CAPE-Vr’s preference for recordings fits telepractice: you rate clean device recordings, not compressed video-call audio.
- Show the sentences on screen so the patient reads them without you modeling the voice.
- Rate in a quiet room with good headphones and note your listening setup on the form.
- Keep the files. Re-rate baseline and follow-up together to reduce drift.
A step-by-step telepractice voice evaluation workflow
- Prepare. Get telehealth consent, confirm you are licensed where the patient is located, make sure your software vendor has signed a BAA, and send the patient the recording checklist.
- Interview by video. Case history, voice use, symptoms, medical history and patient-reported measures such as the VHI-10.
- Record and analyze. Sustained vowels, CAPE-V sentences, connected speech and maximum phonation time. Review CPPS, AVQI, F0 and intensity, and rate the CAPE-V from the recordings.
- Document. Write the evaluation note, set goals and recommend laryngeal imaging when needed. Laryngoscopy cannot be done remotely and is still needed to diagnose the cause.
CPT 92524 documentation for telepractice voice evaluations
CPT 92524 is “Behavioral and qualitative analysis of voice and resonance.” It is one of four SLP evaluation codes that took effect on January 1, 2014, replacing 92506. ASHA notes that instrumental assessments have separate codes, such as CPT 92520 for laryngeal function studies.
Can SLPs bill telehealth in 2026?
For Medicare, yes. The Consolidated Appropriations Act, 2026 (Public Law 119-75, signed February 3, 2026) extended Medicare telehealth flexibilities, including SLPs, physical therapists and occupational therapists as eligible practitioners, through December 31, 2027. Commercial and Medicaid rules vary by payer and state.
Documentation checklist
| Section | What to include |
|---|---|
| Telehealth details | Patient and clinician locations, consent, platform, audio-video vs asynchronous recordings, others present |
| Reason for referral | Referral source, ENT findings if available, onset and history |
| Case history | Voice use, symptoms, medical, medication and reflux history |
| Perceptual evaluation | CAPE-V or CAPE-Vr ratings, resonance, rating conditions |
| Patient-reported outcomes | VHI-10, V-RQOL or others, with scores |
| Objective measures | Acoustic measures (CPPS, AVQI, F0, intensity, MPT), with device and recording conditions |
| Impression | Severity, functional impact, prognosis |
| Plan | Recommendations, referrals (e.g., laryngoscopy), measurable goals, frequency and duration, medical necessity |
Example summary paragraph (illustrative)
Check before you bill: codes, modifiers and place-of-service rules differ by payer and change often. Confirm whether each code is on your payer’s telehealth list, and follow ASHA and payer guidance. This section is general information, not billing or legal advice.
How to run a telepractice voice evaluation in Phonalyze
Phonalyze is a browser-based voice analysis platform built for remote assessment. It covers the recording, analysis and tracking steps above, inside a HIPAA-compliant setup.
- Anonymous SMS links: patients record in their browser with no app and no video-call audio.
- Built-in tasks: sustained vowels, maximum phonation time and CAPE-V sentences.
- Surveys: VHI-10, EAT-10, Cough Severity Index, Dyspnea Index and V-RQOL, tracked over time.
- Reports in seconds: CPP/CPPS, AVQI, harmonicity, jitter, shimmer, pitch, voicing and intensity, via Praat.
- Compliance: HIPAA-compliant hosting, encrypted data and a signed BAA. See our HIPAA buyer’s guide.
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Frequently asked questions
Is smartphone acoustic voice analysis accurate?
It’s reliable for tracking the same patient over time when the same phone, app and distance are used. Absolute values can differ from lab microphones, especially for shimmer, noise ratios and AVQI, so compare patients with their own baseline rather than with lab norms.
Which acoustic measures are most reliable from phone recordings?
F0 is the most stable. CPP/CPPS held up well in recent studies. Shimmer, HNR/NHR and AVQI are more sensitive to noise and device differences.
Can you administer the CAPE-V remotely?
Yes. The patient records the vowel, sentence and connected-speech tasks and you rate them. The 2025 CAPE-Vr recommends rating from audio recordings rather than live voice.
What is CPT 92524?
“Behavioral and qualitative analysis of voice and resonance”, one of four SLP evaluation codes introduced on January 1, 2014. Instrumental assessments use separate codes, such as 92520 for laryngeal function studies.
Can SLPs bill Medicare for telehealth voice evaluations in 2026?
Yes. The Consolidated Appropriations Act, 2026 extended Medicare telehealth flexibilities for SLPs through December 31, 2027. Check each code’s telehealth status and your payer’s rules.
What should a telepractice voice evaluation note include?
Telehealth details, case history, CAPE-V ratings, patient-reported outcomes, acoustic measures with recording conditions, impression, recommendations, goals and medical necessity.
Related reading
References
- Grillo EU, Brosious JN, Sorrell SL, Anand S. Influence of smartphones and software on acoustic voice measures. Int J Telerehabil. 2016;8(2):9–14. PMC5536725
- Nakum M, Joshi N. A preliminary investigation of the reliability of acoustic parameters of voice through smartphone recordings in individuals with dysphonia. Int J Telerehabil. 2023;15(2):e6572. PMC10754240
- Maskeliūnas R, Damaševičius R, Blažauskas T, Pribuišis K, Ulozaitė-Stanienė N, Uloza V. Pareto-optimized AVQI assessment of dysphonia: a clinical trial using various smartphones. Appl Sci. 2023;13(9):5363. doi:10.3390/app13095363
- Smartphone vs oral studio microphone AVQI with added ambient noise. Journal of Voice. 2021. PMID 33676807
- Kempster GB, Nagle KF, Solomon NP. Development and rationale for the Consensus Auditory-Perceptual Evaluation of Voice–Revised (CAPE-Vr). Journal of Voice. 2025. doi:10.1016/j.jvoice.2025.01.022
- American Speech-Language-Hearing Association. New CPT evaluation codes for SLPs. asha.org
- Consolidated Appropriations Act, 2026 (Public Law 119-75), Section 6209: Medicare telehealth extension through December 31, 2027.
For licensed clinicians. Remote evaluation does not replace laryngeal imaging, and this article is not billing or legal advice. Questions? support@phonalyze.com.
— Phonalyze Team