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Coverage criteria policies

Speech Therapy – Rehabilitative

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process and Coverage

Under many HealthPartners plans, the number of speech therapy visits that are covered in one year is limited. Please refer to your plan documents for further information.

The following services are outside the scope of this policy:
  • Cognitive rehabilitation. Please see Related Content at right for link to the Cognitive Rehabilitation policy.
  • Feeding/ oral function therapy for members under age 18. Please see Related Content at right for link to the Feeding/ Oral Function Therapy – Pediatric policy.
  • Habilitative speech therapy. Please see Related Content at right for link to the Speech Therapy – Habilitative policy.

Prior authorization is not required for rehabilitative speech therapy.

Coverage is subject to the indications below and any limits from your member contract.

Indications that are covered

Rehabilitative Speech Therapy
  1. Evaluation of the need for speech therapy is covered.
  2. Treatment by a speech language pathologist required as a result of loss of speech due to illness and/or injury is covered.
  3. Indications for rehabilitative speech therapy may include, but are not limited to:
    1. Impaired swallow and/or speech related to cleft lip/ cleft palate
    2. Auditory/ aural rehabilitation following receipt of initial hearing aid(s), or following cochlear implantation/ auditory brainstem implantation surgery
Feeding/ Oral Function Therapy (adults age 18 and over)
  1. Evaluation of the need for feeding/ oral motor function/ swallowing therapy is covered.
  2. Treatment by a speech pathologist required as a result of loss of feeding/ oral motor function/ swallowing ability due to illness and/or injury is covered.

Indications that are not covered

  1. Treatment of dialect and accent reduction because it does not meet rehabilitative criteria.
  2. Speech therapy to improve speech for a second language.
  3. Group therapy.
  4. Therapy when functional improvement is not expected, or when progress has plateaued.
  5. Voice therapy for any of the following indications:
    1. Vocational/recreational related purposes such as school teacher, choir member, etc.
    2. Chronic laryngitis
    3. Maintenance care or other non-rehabilitative therapies
    4. Progress where functional improvement is not expected.

Definitions

Rehabilitative speech therapy - therapy following a loss of previous function due to an illness or injury. The therapy is performed for the purpose of obtaining significant functional improvement, within a predictable period of time (2 months), toward a maximum potential ability to perform functional activities. This is generally provided by speech pathologists, but may include other practitioners.

Note: Speech therapy for developmental conditions is considered habilitative and requires prior authorization.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

References

  1. American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations [Relevant Paper]. Available from www.asha.org/policy.
  2. American Speech-Language-Hearing Association. (2001). Knowledge and skills required for the practice of audiologic/ aural rehabilitation [Knowledge and Skills.] Available from www.asha.org/policy.
  3. American Speech­Language­Hearing Association. (2004). Admission/discharge criteria in speech-language pathology [Guidelines]. Available from www.asha.org/policy.
  4. American Speech-Language-Hearing Association. (2005). The role of the speech-language pathologist in the performance and interpretation of endoscopic evaluation of swallowing: position statement [Position Statement]. Available from www.asha.org/policy.
  5. Blevins, N. H. Presbycusis. In: UpToDate, Deschler, D. G., & Sullivan, D. J. (Eds.), UpToDate, Waltham, MA. (Accessed on November 1, 2017.)
  6. Cohen, E. E. W., LaMonte, S. J., Erb, N. L., Beckman, K. L., Sadeghi, N., Hutcheson, K. A. … Pratt-Chapman, M. L. (2016). American Cancer Society head and neck cancer survivorship care guideline. CA: A Cancer Journal for Clinicians, 66, 203-239. doi: 10.3322/caac.21343.
  7. De Tanti, A., Zampolini, M., & Pegno, S. on behalf of the CC3 Group. (2015). Recommendations for clinical practice and research in severe brain injury in intensive rehabilitation: the Italian Consensus Conference. European Journal of Physical and Rehabilitation Medicine, 51(1), 89-103.
  8. National Institute for Health and Care Excellence. (2017). Parkinson’s disease in adults. NICE guideline (NG71).
  9. Winstein, C. J., Stein, J., Arena, R., Bates, B., Cherney, L. R., Cramer, S. C., … Zorowitz, R. D. on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research. (2016). Guidelines for adult stroke rehabilitation and recovery: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 47, e98-e169. doi: 10.1161/STR.0000000000000098.

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Policy activity

  • 01/01/1994 - Date of origin
  • 03/01/2018 - Effective date
Review date
  • 11/2017
Revision date
  • 02/23/2018

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