S9128, Speech therapy, in the home, per diem
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- The CPB does not specify required documentation to support coverage because Aetna considers diagnostic tests and treatments for APD experimental and investigational. (No explicit documentation requirements are listed in the policy.)
- Documentation of prior treatments and treatment failures where applicable (e.g., prior pneumatic dilation, prior Heller myotomy, prior botulinum toxin injection) — several POEM reports specify use as 'rescue' after failed prior interventions.
- For stent placement or palliative radiotherapy: documentation of inoperable/unresectable primary esophageal cancer and symptom burden (dysphagia score), and life expectancy considerations (to guide stent vs brachytherapy selection).
- No explicit documentation requirements, test-result requirements, or medical-record documentation instructions are specified in this document excerpt.
Key Coverage Criteria
- None — Aetna considers any diagnostic tests or treatments for the management of auditory processing disorder (APD) (previously known as central auditory processing disorder (CAPD)) experimental and investigational because there is insufficient scientific evidence to support the validity of any diagnostic tests and the effectiveness of any treatment for APD.
- Telerehabilitation delivery of swallowing therapy (as an alternative delivery model; limited evidence)
- Speech therapy for treatment of dysphagia, regardless of the presence of a communication disability, for members who meet the criteria set forth below:
- Member exhibits weight loss or malnutrition because he/she has dysphagia and is unable to obtain adequate nutrition orally;
- Member has a history of, or is at high-risk for, recurrent aspirations or choking;
- Member is unable to swallow and has a nasogastric or gastrotomy tube for nutrition;
12 Active Policies
ANTHEM-CG-REHAB-12, CG-REHAB-12 Rehabilitative and Habilitative Services in the Home Setting: Physical Medicine/Physical Therapy, Occupational Therapy and Speech-Language Pathology
ANTHEM-CG-MED-23, CG-MED-23 Home Health
AETNA-CPB-0668, Auditory Processing Disorder (APD)
AETNA-CPB-0625, Dysphagia Therapy
AETNA-CPB-0444, Early Intervention Programs
Related Codes
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