1.0 CPT CODES
92507, 92508, 92521 - 92524,
92610, 92611, 92630 - 92633
2.0 DESCRIPTION
Speech-Language Pathology (SLP)
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 SLP 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 SLP 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).