1.0 CPT
PROCEDURE CODEs
92507, 92508, 92521 - 92524, 92610,
92611, 92630 - 92633
2.0 DESCRIPTION
Speech-language pathology services that provide
evaluation, treatment, habilitation, and rehabilitation of communication
disorders resulting from congenital anomalies, disease, injury,
hearing loss, pervasive developmental disorders or a therapeutic
process, or other condition, such as pragmatic language impairment,
that prevents or diminishes an individual’s ability to communicate.
3.0 POLICY
3.1 Speech-language
pathology services prescribed and supervised by a physician, certified Physician
Assistant (PA) working under the supervision of a physician, or
certified Nurse Practitioner (NP) may be cost-shared.
3.2 Speech-language
pathology services to improve, restore, or maintain function, or
to minimize or prevent deterioration of function of a patient when
prescribed by a physician, certified PA working under the supervision
of a physician, or certified NP is covered in accordance with the
rehabilitative therapy provisions found in
Section 18.1.
3.3 Videofluoroscopy evaluation in
speech pathology is covered when medically necessary.
4.0 EXCLUSIONS
4.1 Services
provided to address speech, language, or communication disorders
resulting from occupational or educational deficits.
4.2 For beneficiaries
under the age of three, services and items provided in accordance
with the beneficiary’s Individualized Family Service Plan (IFSP)
as required by Part C of the Individuals with Disabilities Education
Act (IDEA), and which are otherwise allowable under the TRICARE
Basic Program or the Extended Care Health Option (ECHO) but determined
not to be medically or psychologically necessary, are excluded.
4.3 For beneficiaries
ages three to 21 who are receiving special education services from
a public educational agency, cost-sharing of outpatient speech services
that are required by the IDEA and which are indicated in the beneficiary’s
Individualized Education Program (IEP), may not be cost-shared except
when the intensity or timeliness of speech services as proposed
by the educational agency are not appropriate medical care.
4.4 Myofunctional
or tongue thrust therapy.
4.5 Maintenance therapy that does
not require a skilled level after a therapy program has been designed
(see
Section 18.1).
4.6 Speech therapists (speech pathologists) are
not authorized to bill using Evaluation and Management (E/M) codes
listed in the Physicians’ Current Procedural Terminology (CPT).