Page 221 - Medicare Benefit Policy Manual

Speech-language pathology services are those services provided within the scope of
practice of speech-language pathologists and necessary for the diagnosis and treatment of
speech and language disorders, which result in communication disabilities and for the
diagnosis and treatment of swallowing disorders (dysphagia), regardless of the presence
of a communication disability. (See Pub. 100-03, chapter 1, §170.3) See section 230.4
of this chapter for benefit policies on speech-language pathologists in private practice
(SLPP). See Pub. 100-08, Medicare Program Integrity Manual, chapter 10, section
12.4.14 for policy on enrollment in an SLPP.

B. Qualified Speech-Language Pathologist Defined

A qualified speech-language pathologist for program coverage purposes meets one of the
following requirements:

• The education and experience requirements for a Certificate of Clinical
Competence in (speech-language pathology) granted by the American Speech-
Language Hearing Association; or

• Meets the educational requirements for certification and is in the process of
accumulating the supervised experience required for certification.

For outpatient speech-language pathology services that are provided incident to the
services of physicians/NPPs, the requirement for speech-language pathology licensure
does not apply; all other personnel qualifications do apply. Therefore, qualified
personnel providing speech-language pathology services incident to the services of a
physician/NPP must meet the above qualifications.

C. Services of Speech-Language Pathology Support Personnel

Services of speech-language pathology assistants are not recognized for Medicare
coverage. Services provided by speech-language pathology assistants, even if they are
licensed to provide services in their states, will be considered unskilled services and
denied as not reasonable and necessary if they are billed as therapy services.

Services provided by aides, even if under the supervision of a therapist, are not therapy
services and are not covered by Medicare. Although an aide may help the therapist by
providing unskilled services, those services are not covered by Medicare and shall be
denied as not reasonable and necessary if they are billed as therapy services.

D. Application of Medicare Guidelines to Speech-Language Pathology Services

1. Evaluation Services

Speech-language pathology evaluation services are covered if they are reasonable and
necessary and not excluded as routine screening by §1862(a)(7) of the Act. The speech-