Speech Therapy
EVICORE-SPEECH-THERAPY-GUIDELINES
Speech-language pathology services (evaluation/treatment of speech, language, voice, motor‑speech, swallowing/dysphagia, aural rehabilitation, cognitive‑communication and pediatric developmental disorders) are covered when they treat impairments from illness, injury or developmental disorder and are expected to produce significant functional improvement or require skilled maintenance; excluded are non‑skilled, preventive or palliative‑only services, enhancement/educational services (e.g., accent reduction, transgender voice modification, many mild developmental/learning issues), duplicate therapy, services by unlicensed providers, and modalities lacking evidence. Key requirements: physician order; services delivered by a licensed SLP with a treatment plan containing baseline data and measurable goals, per‑encounter progress notes, periodic reassessments (adults 30–60 days, children 6–9 months), documented justification for instrumental studies, group size ≤4 with individualized goals, and discharge/transition if no measurable improvement.