Speech Therapy Guidelines

Covered: speech‑language pathology services (including AAC and medically necessary SGDs as DME) to treat impairments from disease, injury, developmental or surgical causes (aphasia, apraxia, dysarthria, dysphagia, ASD, TBI/stroke, habilitation and skilled maintenance); excluded: palliative‑only or preventive screenings, non‑skilled/repetitive procedures, duplicate therapy, many educational/developmental or cosmetic services (e.g., accent modification), and ongoing treatment without measurable improvement. Key requirements: services must be medically necessary and evidence‑based with measurable functional goals, ordered by a physician, supported by comprehensive evaluation/treatment plans and periodic reassessments (adults 30–60 days; children 6–9 months), and require prior authorization and full documentation (including AAC/SGD trials/justification) to establish coverage.

"Non-response to treatment justifies discharge (listed under Discharge Criteria)"