ModifiedKaiser PermanentePolicy N/A

Speech Language Therapy

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Defines medical necessity criteria, continuation requirements, exclusions, and applicable CPT/HCPCS codes for outpatient, home, inpatient, voice, auditory/aural, and swallowing/feeding speech-language therapy services for Kaiser Foundation Health Plan of Washington members.

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ModifiedKaiser PermanentePolicy N/A

Speech Language Therapy

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Coverage Summary

Summary: This policy defines medical necessity criteria for outpatient, home, and inpatient speech‑language therapy services (including voice, auditory/aural rehabilitation, and swallowing/feeding therapy) provided episodically by licensed speech‑language pathologists or supervised assistants; services are covered with criteria and require documented evaluation, individualized plans, and progress monitoring. Effective date: 2025-02-01.

Surface thresholds and quick facts

Evaluation recency thresholdEvaluation completed within the last 12 months

Effective date2025-02-01

Last review date2024-11-05

Next review date2025-11-04

Covered CPT/HCPCS codes listed13

Not medically necessary codes listed3

Experimental modality group (electrical stimulation)1

Medical-Necessity Criteria

Not Medically Necessary & Experimental Services

Exclusions: Educational learning services (reading, writing, spelling) without a documented spoken language disorder are not covered or reimbursable; HCPCS/CPT codes S9445 and S9446 are considered not medically necessary as they are part of usual evaluation/management; electrical stimulation modalities for swallowing/feeding (e.g., 97014, 97032, G0283) are considered experimental, investigational, or unproven.

Coding

Considered Medically Necessary when criteria are metCPTCovered

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, 2 or more individuals.
92521	Evaluation of speech fluency (eg, stuttering, cluttering).
92522	Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria).
92523	Evaluation of speech sound production with evaluation of language comprehension and expression.
92524	Behavioral and qualitative analysis of voice and resonance.
92526	Treatment of swallowing dysfunction and/or oral function for feeding.
92609	Therapeutic services for the use of speech-generating device, including programming and modification.
92610	Evaluation of oral and pharyngeal swallowing function.
92626	Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status; first hour.

1–10 of 13

1/2

Considered Not Medically Necessary (part of usual evaluation and management)HCPCS|CPTNot Covered

S9445	Patient education, not otherwise classified, nonphysician provider, individual, per session.
S9446	Patient education, not otherwise classified, nonphysician provider, group, per session.

Considered Not Medically Necessary - experimental/investigational/unprovenCPT|HCPCSExperimental

97014	Application of a modality to 1 or more areas; electrical stimulation (unattended).
97032	Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes.
G0283	Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care.

Provider Actions & Billing Guidance

Documentation Required

Evaluation documentation required

Submit an evaluation completed within last 12 months by a certified speech-language pathologist including age-appropriate standardized tests or measures that quantify impairment; for VFSS results required for swallowing/feeding therapy.

Evaluation recency: within last 12 months
VFSS results required for swallowing/feeding therapy

Documentation Required

Therapy plan documentation

Therapy plan must include quantifiable, attainable short- and long-term treatment goals and documentation of progress and generalization; continuation requires documented quantifiable improvement and active participation.

Documented quantifiable improvement toward established short- and long-term treatment goals
Demonstrated functional progress
Generalization and carryover of targeted skills into the natural environment

Background

Background: Services must be delivered by licensed speech‑language pathologists (or licensed assistants under supervision) and are provided episodically in outpatient, inpatient, and home settings; caregiver‑facilitated interventions may be used under SLP guidance. Therapy must be individualized with quantifiable short‑ and long‑term goals and documented progress, and evaluations (including VFSS when required for swallowing/feeding) are expected to support medical necessity and ongoing treatment decisions.

Definitions

TermCommunication disorder

DefinitionAn impairment in the ability to receive, send, process, and comprehend verbal, nonverbal and graphic symbol systems; may affect hearing, language, and/or speech.

Medicare Determinations

Number	Name	Effective Date
170.3	Speech-Language Pathology Services for the Treatment of Dysphagia
Type: NCD	Source: Medicare Members section

Revision History

2024-09-03material_change

MPC approved to adopt criteria for Speech/Language Therapy Services for non-Medicare members; requires 60-day notice.

2025-02-01effective_dateLatest

Policy change becomes effective (60-day notice period concluded).