Speech Language Pathology Services

Covered: skilled SLP rehabilitative, habilitative, or maintenance services are medically necessary when there is standardized, documented evidence of a significant functional deficit affecting ADLs/IADLs that is complex enough to require a qualified provider; excluded are non‑skilled, preventive, routine, duplicative, elective/recreational or purely academic needs and care that is primarily passive (NMES alone for dysphagia is not established). Key requirements: standardized baseline and periodic assessments (in all languages the patient uses) with objective measures of deficit and response (quantified at least annually), a reasonable, evidence‑based plan of care with expected improvement or need for ongoing skilled modification, documented patient/caregiver compliance, and an audiologist diagnosis before SLP intervention for hearing/central auditory processing issues.

"The initiation of an episode of speech language pathology services for skilled habilitation/rehabilitation will be considered medically necessary when current information is submitted to demonstrat..."