Page 222 - Medicare Benefit Policy Manual

language pathologist employs a variety of formal and informal speech, language, and
dysphagia assessment tests to ascertain the type, causal factor(s), and severity of the
speech and language or swallowing disorders. Reevaluation of patients for whom speech,
language and swallowing were previously contraindicated is covered only if the patient
exhibits a change in medical condition. However, monthly reevaluations; e.g., a Western
Aphasia Battery, for a patient undergoing a rehabilitative speech-language pathology
program, are considered a part of the treatment session and shall not be covered as a
separate evaluation for billing purposes. Although hearing screening by the speech-
language pathologist may be part of an evaluation, it is not billable as a separate service.

2. Therapeutic Services

The following are examples of common medical disorders and resulting communication
deficits, which may necessitate active rehabilitative therapy. This list is not all-inclusive:

Cerebrovascular disease such as cerebral vascular accidents presenting with
dysphagia, aphasia/dysphasia, apraxia, and dysarthria;

Neurological disease such as Parkinsonism or Multiple Sclerosis with dysarthria,
dysphagia, inadequate respiratory volume/control, or voice disorder; or

Laryngeal carcinoma requiring laryngectomy resulting in aphonia.

3. Impairments of the Auditory System

The terms, aural rehabilitation, auditory rehabilitation, auditory processing, lipreading
and speech reading are among the terms used to describe covered services related to
perception and comprehension of sound through the auditory system. See Pub. 100-04,
chapter 12, section 30.3 for billing instructions. For example:

° Auditory processing evaluation and treatment may be covered and medically
necessary. Examples include but are not limited to services for certain
neurological impairments or the absence of natural auditory stimulation that
results in impaired ability to process sound. Certain auditory processing
disorders require diagnostic audiological tests in addition to speech-language
pathology evaluation and treatment.

° Evaluation and treatment for disorders of the auditory system may be covered
and medically necessary, for example, when it has been determined by a speech-
language pathologist in collaboration with an audiologist that the hearing
impaired beneficiary’s current amplification options (hearing aid, other
amplification device or cochlear implant) will not sufficiently meet the patient’s
functional communication needs. Audiologists and speech-language pathologists
both evaluate beneficiaries for disorders of the auditory system using different
skills and techniques, but only speech-language pathologists may provide
treatment.