CurrentAetnaPolicy 0284

Melodic Intonation Therapy

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This policy governs coverage and clinical criteria for melodic intonation therapy (MIT) for Aetna members, specifying when MIT is considered medically necessary, investigational, and any limitations or exclusions, and who may administer it.

Policy Summary

PayerAetna

PolicyMelodic Intonation Therapy

Policy CodePolicy 0284

Change TypeNo material clinical or coverage changes in this revision.

Effective DateJun 8, 2001

Last ReviewMay 4, 2023

Next Review DateMar 14, 2024

Key ActionDocument clinical findings demonstrating Broca's (non-fluent) aphasia and that all five selection criteria are met to support medical necessity for MIT.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5Required selection criteria

30-minSession length

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CurrentAetnaPolicy 0284

Melodic Intonation Therapy

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Policy Summary

PayerAetna

PolicyMelodic Intonation Therapy

Policy CodePolicy 0284

Change TypeNo material clinical or coverage changes in this revision.

Effective DateJun 8, 2001

Last ReviewMay 4, 2023

Next Review DateMar 14, 2024

Key ActionDocument clinical findings demonstrating Broca's (non-fluent) aphasia and that all five selection criteria are met to support medical necessity for MIT.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5Required selection criteria

30-minSession length

Multiple CPT/ICDCode listings

SeveralInvestigational indications

Coverage Criteria

Medical Necessity for Broca's (non-fluent) aphasia

Covered when ALL of the following are met

MIT medical necessity criteria: 1. Member has good auditory comprehension; 2. Member is well-motivated, emotionally stable, and has a good auditory span; 3. Member's repetition is poor, even for single words; 4. There is no evidence of bilateral brain involvement; 5. Verbal production is non-fluent, with diminished articulator agility and effortful initiation of speech production.all 5 criteria required

Each numbered item must be met for coverage.

Experimental and Investigational indications

The following uses are considered experimental and investigational (not an all-inclusive list)

MIT experimental indications: Melodic intonation therapy for dysarthria; verbal apraxia; other types of aphasia; raising trans women's singing and speaking fundamental frequencies; and for all other indications; and combinational use of transcranial magnetic stimulation / transcranial brain stimulation with melodic intonation therapy for the treatment of aphasia.any listed indication

These uses are considered investigational because effectiveness has not been established.

Melodic intonation therapy (MIT) is considered investigational for several uses where effectiveness has not been established. Specifically, MIT is not covered for treatment of dysarthria, verbal apraxia, or other types of aphasia, nor for use to raise trans women’s singing and speaking fundamental frequencies. In addition, the combined use of MIT with transcranial magnetic stimulation or other transcranial brain stimulation techniques for aphasia is considered investigational.

This Clinical Policy Bulletin provides a partial, general description of plan or program benefits and is intended to assist in administering those benefits. It does not constitute a contract, an offer of coverage, or medical advice. Aetna does not provide health care services and cannot guarantee results; participating providers are independent contractors and treating providers remain solely responsible for medical advice and treatment of members.

Examples of ICD-10–coded conditions that are covered when the MIT selection criteria for Broca’s (non‑fluent) aphasia are met include codes for aphasia and sequelae of cerebrovascular disease with aphasia such as I69.020, I69.120, I69.220, I69.320, I69.820, I69.920, and R47.01 (aphasia). Conversely, ICD-10 codes listed as not covered for the indications in this policy include gender identity disorders (F64.0–F64.9), specific developmental disorders of speech and language (F80.0–F80.9), dysarthria and anarthria (R47.1), and agnosia/apraxia and other symbolic dysfunctions (R48.1–R48.8).

Coding

Other CPT/HCPCS codes related to the CPBmixed

90867	Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management.
90868	Subsequent delivery and management, per session.
90869	Subsequent motor threshold re-determination with delivery and management.
92507	Treatment of speech, language, voice communication, and/or auditory processing disorder; individual.
92508	Treatment of speech, language, voice communication, and/or auditory processing disorder; group, two or more individuals.
G0153	Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes.
S9128	Speech therapy, in the home, per diem.

ICD-10 codes covered if selection criteria are metICD-10Covered

I69.020	Sequelae of cerebrovascular disease, aphasia.
I69.120	Sequelae of cerebrovascular disease, aphasia.
I69.220	Sequelae of cerebrovascular disease, aphasia.
I69.320	Sequelae of cerebrovascular disease, aphasia.
I69.820	Sequelae of cerebrovascular disease, aphasia.
I69.920	Sequelae of cerebrovascular disease, aphasia.
R47.01	Aphasia.

ICD-10 codes not covered for indications listed in the CPBICD-10Not Covered

F64.0 - F64.9	Gender identity disorders.
F80.0 - F80.9	Specific developmental disorders of speech and language.
R47.1	Dysarthria and anarthria.
R48.1 - R48.8	Agnosia, apraxia and other symbolic dysfunctions.

Provider Actions & Requirements

Prior Authorization

Prior authorization may be required for related therapy codes

Prior authorization may be required for speech therapy services billed under related CPT/HCPCS codes listed in the policy; ensure appropriate code selection and medical necessity documentation when submitting claims for these services.

Codes listed in the policy include 92507, 92508, G0153, S9128, and TMS codes 90867–90869.

Note

Prior authorization not specified in this section

This section of the Clinical Policy Bulletin does not itself specify any prior authorization procedures or list specific affected billing codes for prior authorization determinations.

Note

Medicare NCD: coverage for nonfluent aphasia after conventional therapy

Background

Aphasia is a loss or degradation of language ability due to lesions in cortical language areas or their associations. Broca’s aphasia (also called expressive or non‑fluent aphasia) primarily affects spoken language production and is characterized by effortful, non‑fluent verbal output with reduced articulatory agility and difficulty initiating speech; auditory comprehension is relatively preserved. Melodic intonation therapy uses melodic and rhythmic elements (e.g., humming, singing two‑note patterns, and rhythmic tapping) to engage alternative neural resources and facilitate recovery of propositional speech in individuals with non‑fluent (Broca’s) aphasia.

Definitions

Melodic intonation therapy (MIT) — definition

DefinitionMelodic intonation therapy (MIT) is a speech-language therapy that uses melodic (two-note: high and low) and rhythmic (two durations: long and short) components to encourage humming and singing of words/phrases with rhythmic tapping to facilitate speech recovery in individuals with non-fluent (Broca's) aphasia.

Key componentsMelodic component: simplified/exaggerated prosody with two notes (high and low); Rhythmic component: two durations (long and short) often combined with rhythmic tapping.

Primary techniques usedEncouraging humming, then singing target words/phrases, paired with rhythmic tapping to support production.

Intended effectProvides an alternative neural strategy for word/phrase recall by leveraging brain regions used for music and song, potentially increasing the number of words a person can recall.

Limitations notedMost aphasic patients do not respond to MIT; it is less effective for global or transcortical aphasia and when there is significant posterior language-area involvement.

Policy Summary

PayerAetna

PolicyMelodic Intonation Therapy

Policy CodePolicy 0284

Change TypeNo material clinical or coverage changes in this revision.

Effective DateJun 8, 2001

Last ReviewMay 4, 2023

Next Review DateMar 14, 2024

Key ActionDocument clinical findings demonstrating Broca's (non-fluent) aphasia and that all five selection criteria are met to support medical necessity for MIT.

SourceLink

On This Page

A Medicare National Coverage Determination (1983) states that MIT is covered only for nonfluent aphasic patients unresponsive to conventional therapy and only when the conditions for coverage of speech pathology services are met.

Implies MIT is considered after conventional therapy has failed for eligible nonfluent (Broca's) aphasia patients.

Documentation Required

Provider responsibility and policy advisory

Treating providers are solely responsible for medical advice and treatment of members; this Clinical Policy Bulletin provides guidance to assist in administering plan benefits but is not a substitute for clinical judgment.

The bulletin is a partial, general description of plan benefits and does not constitute a contract or offer of coverage.

Documentation Required

Document clinical findings that meet all medical necessity criteria

Clinical documentation must demonstrate the presence of Broca's (non‑fluent) aphasia and that all medical necessity selection criteria are met before MIT is considered covered.

Document good auditory comprehension.
Document motivation, emotional stability, and adequate auditory span.
Document poor repetition (even for single words).
Document absence of bilateral brain involvement.
Document non‑fluent verbal production with diminished articulator agility and effortful initiation of speech.
Include justification for session length and frequency in clinical notes.

Denial Risk

Risk of claim denial if selection criteria are not fully met

Services that do not meet ALL five medical necessity selection criteria for Broca's (non‑fluent) aphasia are at risk of denial.

All five criteria must be met: good auditory comprehension; well‑motivated/emotionally stable with good auditory span; poor repetition; no bilateral brain involvement; non‑fluent verbal production.

Note

Policy is administrative guidance and not an offer of coverage

Clinical Policy Bulletins are developed to assist in administering plan benefits, do not constitute offers of coverage, and participating providers are independent contractors.

Aetna does not provide health care services and cannot guarantee outcomes; the bulletin is subject to change.

Note

Provider/plan disclaimer — administrative context and responsibilities

Clinical Policy Bulletins assist in administering plan benefits but are not contracts; treating providers remain solely responsible for medical advice and treatment, and the bulletin may be updated.

Participating providers are independent contractors and not employees or agents of Aetna.

Broca's aphasia — definition

DefinitionBroca's aphasia (expressive or non-fluent aphasia) is a disorder of spoken language production caused by lesions in anterior/perisylvian language areas (Broca's area), characterized by impaired speech production with relatively preserved comprehension.

Alternate namesAlso called non-fluent, anterior, or motor aphasia.

Primary clinical featuresImpaired spoken language production with effortful, non-fluent speech; reduced articulator agility and difficulty initiating speech.

Contrast with other aphasiasReceptive (Wernicke's) aphasia affects language comprehension and interpretation; global aphasia involves extensive loss of speech and language functions due to large perisylvian lesions.