CurrentUnitedHealthcarePolicy N/A

Services Not Reimbursable to Speech‑Language Therapists/Pathologists

Defines CPT/HCPCS and related codes that UnitedHealthcare Community Plan will not reimburse when billed by Speech‑Language Therapists/Pathologists; applies to Community Plan Medicaid and Medicare products and claims submitted on CMS‑1500 or electronic equivalent.

Policy Summary

PayerUnitedHealthcare

PolicyServices Not Reimbursable to Speech‑Language Therapists/Pathologists

Policy CodePolicy N/A

Change TypeAttachments updated

Effective DateN/A

Next Review DateN/A

Key ActionSubmit speech therapy services under a written plan of care and include HCPCS modifier GN for outpatient speech‑language pathology 'always therapy' services when appropriate.

SourceLink

POLICY UPDATE CHANGES

Attachments Section: List updated

History Section: Entries prior to 1/1/2024 archived

CMS-1500claim form(s) covered by this policy

Medicaid & Medicareproducts covered

multipleattachment list updated (history)

Coverage Criteria

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage rules for speech‑language therapy billing

UnitedHealthcare Community Plan will not reimburse the listed CPT/HCPCS codes when reported by Speech‑Language Therapists/Pathologists.

Codes listed in the 'Services Not Reimbursable to Speech‑Language Therapists/Pathologists' attachment are not reimbursed when billed by Speech‑Language Therapists/Pathologists.

Services must relate directly and specifically to a written speech therapy plan of care established before treatment; there shall be separate plans of care for each therapy discipline.

Submit HCPCS modifier GN for outpatient speech‑language pathology 'always therapy' service codes provided by a Speech‑Language Pathologist when appropriate; use of modifier GN does not permit billing for services outside the provider's recognized scope of practice.

Policy applies to Community Plan Medicaid and Medicare products and to services billed on CMS‑1500 or electronic equivalent by all network and non‑network qualifying providers.

Note: The detailed list of non‑reimbursable codes is maintained in an attachments section and has been updated per the policy history.

Coding and Billing Requirements

Non-reimbursable codes when billed by Speech-Language Therapists/PathologistsmixedNot Covered

List of CPT/HCPCS codes from Physical Medicine and Rehabilitation, Evaluation and Management, Adaptive Behavior Assessment and other CPT sections that will not be reimbursed when reported by Speech-Language Therapists/Pathologists (see attachments).

Plan of care requirement

Plan of care requirementServices must relate directly and specifically to a written speech therapy treatment plan (plan of care) that is established before treatment has begun; the plan must specify the speech therapy services planned.

Separate plans per disciplineThere must be different plans of care for each therapy discipline (e.g., a Speech Therapist may not provide services under a Physical Therapist plan of care).

Initiation of therapyTherapy may be initiated by a Speech-Language Therapist/Pathologist based on the established plan of care.

Plan specificityServices must relate directly and specifically to the written plan of care rather than general or unrelated treatment.

Provider Actions and Submission Guidance

Prior Authorization

Submit under written plan of care and use HCPCS modifier GN

Submit speech therapy services under a written speech therapy treatment plan (plan of care) that is established before treatment begins; the plan of care must specify the speech therapy services planned and separate plans are required for each therapy discipline. When reporting outpatient speech‑language pathology 'always therapy' service codes provided by a Speech‑Language Pathologist, submit HCPCS modifier GN; note that use of the GN modifier does not permit providers to bill for services they are not qualified to perform. Providers remain responsible for submitting accurate claims and using codes that correctly describe services.

Plan of care must be written and established before treatment and must specify planned speech therapy services.
Different plans of care are required for different therapy disciplines.
Submit HCPCS modifier GN with outpatient speech‑language pathology 'always therapy' codes when appropriate.
GN modifier does not authorize provision of services outside the provider’s recognized scope.
Providers are responsible for accurate claim submission and correct code use.

Billing Rule

Applicability to CMS‑1500 claims and all providers

This policy applies to services reported using the CMS‑1500 (1500 Health Insurance Claim Form) or its electronic equivalent and to UnitedHealthcare Community Plan Medicaid and Medicare products; it applies to all network and non‑network physicians and other qualified health care professionals.

Applies to CMS‑1500 claims and electronic equivalent.
Covers Community Plan Medicaid and Medicare products.
Applies to all network and non‑network physicians and other qualified health care professionals.

Definitions

Scope of services

Scope of practiceServices provided must be within the scope of practice of Speech-Language Therapists/Pathologists and consistent with applicable State and local law.

Speech and language disordersServices necessary for the diagnosis and treatment of speech and language disorders that result in a communication disability.

Swallowing disorders (dysphagia)Services for the diagnosis and treatment of swallowing disorders (dysphagia) are included, regardless of presence of a communication disability.

Plan-based servicesServices must relate directly to a written speech therapy treatment plan and specify the planned speech therapy services.

GN (HCPCS) modifier

Modifier GN definitionHCPCS modifier GN indicates services delivered under an outpatient speech-language pathology plan of care; submit with speech therapy service codes considered by CMS to be 'always therapy' when provided by a Speech-Language Pathologist.

When to submitSubmit GN with any speech therapy service codes provided by a Speech-Language Pathologist that CMS classifies as 'always therapy'.

LimitationsUse of the GN modifier does not permit a Speech-Language Therapist/Pathologist to deliver services they are not qualified and recognized to perform.

Modifier purposeModifiers are used to identify therapy services whether or not financial limitations are in effect.