Speech Language Pathology Guidelines

SLP services are covered when they treat a functional communication or swallowing deficit from illness/injury/congenital disorder that requires a qualified therapist, is an accepted effective treatment, and is reasonably expected to produce significant improvement (includes AAC, aural rehab, (C)APD, dysphagia, ASD, bilingual needs and skilled maintenance); services are excluded when needs can be met by an independent home program, are routine/non‑skilled, have met goals or show no objective improvement, are commensurate with peers, duplicate care, or when the patient is noncompliant or medically unable to tolerate therapy (NMES alone for dysphagia and certain intensive feeding therapies are not supported). Authorization requires documentation of the functional deficit and need for therapist skills, baseline and current objective measures tied to goals (often standardized scores showing >1 SD delay where specified), hearing/audiology confirmation, relevant instrumental assessments (e.g., VFSS/FEES, laryngeal studies) as applicable, and evidence of progress for continuation or justification for maintenance.