Speech Therapy Guidelines

eviCore covers skilled speech‑language pathology services for clinically significant impairments (speech, language, voice, swallowing/dysphagia, cognitive‑communication, AAC, ASD, apraxia, feeding disorders, etc.) that interfere with ADLs and are expected to produce measurable functional improvement, and excludes non‑skilled or repetitive procedures, preventive/palliative‑only care, duplicate therapy, services for mild developmental delays (≤1 SD), accent modification/professional communication training, and other specified non‑covered conditions. Coverage requires objective evidence (standardized tests/assessments—commonly >1 SD or >2 SD where specified), evaluation by an ASHA‑certified SLP, a treatment plan with measurable functional goals, documented periodic reassessments (typically every 30–60 days for adults and annually for children), comprehensive documentation and prior‑authorization timeliness; maintenance coverage and some modalities (e.g., NMES‑alone for dysphagia) are limited or plan‑specific.