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).