Melodic Intonation Therapy
Customize your policy alerts
Sign up for Aetna Policy 0284 alerts
Get alerted when Policy 0284 changes without checking for updates manually.
Monitor payer policy activity
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.
No material clinical or coverage changes in this revision.
Coverage Criteria
Medical Necessity for Broca's (non-fluent) aphasia
Covered when ALL of the following are met
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)
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
| 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. |
| 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. |
| 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 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.
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.
Medicare NCD: coverage for nonfluent aphasia after conventional therapy
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.
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.
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.
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.
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.
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.
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
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.