Insurance Reimbursement For Speech Therapy
Refer to the speech therapy section in this manual for policy information.
Insurance reimbursement for speech therapy. In the meantime the client is responsible for the. The following new cpt codes are effective january 1 2020. Outpatient speech language pathology services provided under part b of the medicare program are paid under the medicare physician fee schedule mpfs. The following are additions revisions and deletions to current procedural terminology cpt american medical association codes for speech language pathologists effective january 1 2020.
Instead the client must seek reimbursement from the insurer. The medicare payment will be the lower of the actual charge or the fee schedule allowance. Provide speech therapy write up a bill send it to the insurance company then get paid. The fee schedule is updated annually.
You will qualify for the reimbursement of speech therapy if. The care has a medical purpose and the treatment can be expected to result in the restoration or improvement of the speech function or power of speech. Speech language pathology services medicare part b medical insurance helps pay for medically necessary outpatient speech language pathology services. Reimbursement will be made at the provider s usual charge to the general public not to exceed the following maximum allowances california code of regulations ccr title 22 section 51507 2.
Speech language pathology services under medicare part b have reimbursement rates established by the medicare physician fee schedule regardless of provider setting. Payment is determined by the fee associated with a specific procedure code in those settings. Reimbursement is not guaranteed and the client may have to jump through many hoops. Your costs in original medicare you pay 20 of the medicare approved amount and the part b deductible applies.
If the reimbursement is from a private insurance company the speech language pathologist or audiologist should refer to the contract between the provider and the health plan.
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