Criteria
Coverage is subject to the specific terms of the member's benefit plan.
Speech therapy services may be considered medically necessary when ordered by a physician and performed by a licensed speech pathologist/therapist. Speech therapy services must be directed to the active treatment of at least
ONE
of the following conditions:
- Primary disorder of speech or hearing related organs, e.g., congenital malformations such as cleft lip/palate, or craniofacial disorders, (this is not an all-inclusive list).
- Secondary disorder impacting speech or hearing, e.g., chronic ear infections, post-stroke, vocal cord lesions or trauma, (this is not an all-inclusive list).
Voice therapy may be considered medically necessary for
ANY
of the following conditions (this is not an all-inclusive list):
-
Closed head trauma;
or
-
Laryngeal trauma and trauma related dysphonia's;
or
-
Polyps;
or
-
Vocal Cord Lesions;
or
-
Vocal Cord Paralysis Or Paresis;
or
-
Vocal Cysts;
or
- Vocal nodules.
NOTE:
Voice therapy provided prior to surgery is not a covered service.
Speech therapy services must achieve a specific diagnosis-related goal for a individual who has a reasonable expectation of achieving measurable improvement in a reasonable and predictable period of time. These services must also provide specific, effective, and reasonable treatment for the individual's diagnosis and physical condition.
Speech therapy should be provided in accordance with an ongoing, written therapy plan.
NOTE: Neuromuscular electrical stimulation where a small current is passed through external electrodes placed on the neck to stimulate inactive or atrophied swallowing muscles may be considered medically necessary as an adjunct to treatment techniques and exercises.
Procedure Codes
92507 | 92508 | 92521 | 92522 | 92523 | 92524 | 92526 |
92597 | 92607 | 92608 | 92609 | 92610 | 92611 | 96105 |
96125 | 97032 | 97129 | 97130 | 97799 | G0153 | G0161 |
S9128 | S9152 |
