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TRICARE Policy Manual 6010.60-M, April 1, 2015
Chapter 7
Section 7.1
Speech Services
Issue Date:  April 19, 1983
Authority:  32 CFR 199.6(c) and 10 USC 1079(e)
Copyright:  CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Revision:  C-18, February 21, 2018
92507, 92508, 92521 - 92524, 92610, 92611, 92630 - 92633
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.
3.1  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.
4.1  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).
5.0  Effective Date
January 1, 2004, for videofluoroscopy evaluation.
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