Speech-Language Pathology Medical Review Guidelines
Speech-Language PathologyMedical Review GuidelinesAmerican Speech-Language-Hearing Association
Speech-Language PathologyMedical Review GuidelinesAmerican Speech-Language-Hearing Association
General InformationThe Speech-Language Pathology Medical Review Guidelines, published by the AmericanSpeech-Language-Hearing Association (ASHA), were developed by the 2008 Ad Hoc Committeeon Speech-Language Pathology Medical Review Guidelines, consisting of ASHA-certified speechlanguage pathologists Becky Cornett (chair), Diane Ross, Lynne F. Harmon, Gretchen Bebb, andPat Ford, who developed this document in conjunction with Janet McCarty, private health plansadvisor, and Neela Swanson, health care financing information coordinator. Vice President forGovernment Relations & Public Policy Thomas J. Hallahan served as the Board of Directorsliaison and monitoring officer for the committee and Director of Health Care Economics andAdvocacy Steven C. White served as consultant.Information in this publication continues to be updated by ASHA’s Health Care Economics &Advocacy Team on an as-needed basis.Copies may be obtained as follows: online: view-guidelines/e-mail: reimbursement@asha.orgphone: 800-498-2071 (ask to speak to a member of the Health Care Economics &Advocacy Team)Copyright 2015 American Speech-Language-Hearing Association
Table of ContentsSection I. 1Introduction . 3Definition of Speech-Language Pathology . 4Etiologies . 4Assessment, Diagnosis, Treatment, Referral . 4Speech-Language Pathology Providers . 6ASHA Certification . 6Clinical Documentation . 6Types of Documentation. 7Medical Necessity of Speech-Language Pathology Services . 8Why Speech-Language Pathology Services Meet the Definition of MedicalNecessity . 10ASHA’s Treatment Efficacy Summaries. 10Prevalence and Incidence of Communication and Swallowing Disorders At-aGlance . 10Definition of a Communication Disorder . 12Clinical Coverage Concepts . 12Habilitative Services . 12Rehabilitative Services . 12Developmental Conditions . 12Group Treatment . 13Maintenance Programs. 13Section II. 14Speech-Language Pathology Treatments and Procedures . 16Augmentative and Alternative Communication/Speech-Generating Devices . 16Audiologic Rehabilitation or Auditory Rehabilitation (See also Hearing Disorder). 18(Central) Auditory Processing Treatment (See also (Central) Auditory ProcessingDisorder) . 18Cognitive-Communication Treatment (Cognitive Deficits, CognitiveRehabilitation; See also Cognitive-Communication Disorder) . 19Fluency Treatment (Stuttering, Cluttering; See also Stuttering and ClutteringDisorder) . 19
Language Treatment (Receptive, Expressive, Pragmatics or SocialCommunication, Reading, Writing; See also Language Disorder) . 20Myofunctional Treatment (Tongue Thrust; See also Myofunctional Disorder) . 21Myofunctional disorder is a disorder of tongue and lip posture and movement.Treatment focuses on mod . 21Neurological Motor-Speech Treatment . 21Social Communication Treatment (See also Language Treatment, SocialCommunication Disorder) . 22Speech Sound Disorders Treatment (Articulation Disorder Treatment,Phonological Process Disorder Treatment) . 22Swallowing Treatment (See also Dysphagia, Swallowing Disorder) . 23Voice and/or Resonance Treatment (See also Voice and/or Resonance Disorder). 26Section III. 31Speech-Language Pathology Diagnoses & Related Medical Conditions . 33Amyotrophic Lateral Sclerosis (ALS) . 33Aphasia . 33Apraxia (Including Childhood Apraxia of Speech). 34Autism Spectrum Disorder . 35(Central) Auditory Processing Disorder [See also (Central) Auditory ProcessingTreatment] . 36Cerebral Palsy. 37Cleft Lip and Palate . 37Cognitive-Communication Disorder (Cognitive Deficits, Cognitive Rehabilitation;See also Cognitive-Communication Treatment, Traumatic Brain Injury) . 39Dementia. 39Dysarthria . 40Dysphagia (Swallowing Disorder), Adult and Pediatric (See also SwallowingTreatment) . 41Head and Neck Cancer . 41Hearing Disorder . 42Language Disorder (Spoken Language Comprehension and Expression,Pragmatics or Social Communication; See also Language Treatment) . 43Laryngectomy. 44Multiple Sclerosis . 45
Myofunctional Disorder (Tongue Thrust; See also Myofunctional Treatment) . 46Neurological Motor Speech Disorder (See also Neurological Motor SpeechTreatment, Apraxia, Dysarthria) . 46Paradoxical Vocal Fold Motion Disorder . 47Parkinson’s Disease . 47Social Communication Disorder (See also Language Disorder, LanguageTreatment) . 48Speech Sound Disorders (Articulation Disorder, Phonological Process Disorder;See also Speech Sound Disorders Treatment) . 48Stuttering and Cluttering Disorder (See also Fluency Treatment) . 48Traumatic Brain Injury (Cognitive Deficit, Cognitive Rehabilitation; See alsoCognitive-Communication Disorder, Cognitive-Communication Treatment) . 49Velopharyngeal Dysfunction (See also Cleft Lip and Palate, Voice and/orResonance Treatment, Voice and/or Resonance Disorder) . 50Voice and/or Resonance Disorder (See also Velopharyngeal Dysfunction, Cleft Lipand Palate, Voice and/or Resonance Treatment; Laryngectomy) . 51Section IV . 53Speech-Language Pathology Instrumentation. 55Dysphagia Instrumental Assessment . 55Electrolarynx . 56Laryngeal Function Studies . 56Velopharyngeal Dysfunction Instrumental Assessment . 56Videostroboscopy . 57Speech-Language Pathology Prosthetics . 57Tracheoesophageal Prosthesis (TEP) . 57Tracheostomy Speaking Valves . 58Cochlear Implants . 58Laryngeal Implants . 59Section V . 61Applicable Billing Codes: CPT, ICD-10-CM, HCPCS Codes . 62Current Procedural Terminology (CPT) . 62International Classification of Diseases, 10th Revision, Clinical Modification (ICD10-CM) . 64Health Care Procedure Coding System National (HCPCS) Level II Codes . 64Section VI . 68
Section IOverviewSpeech-Language Pathology Medical Review Guidelines1
Speech-Language Pathology Medical Review Guidelines2
IntroductionThe purpose of the medical review guidelines for speech-language pathology is to serve as aresource for health plans to use in all facets of claims review and policy development. Theguidelines provide an overview of the profession of speech-language pathology includingspeech-language pathologist qualifications, standard practices, descriptions of services,documentation of services, and treatment efficacy data.The American Speech-Language-Hearing Association (ASHA) is the national professional,scientific, and credentialing association for more than 182,000 members and affiliates who areaudiologists; speech-language pathologists; speech, language, and hearing scientists; audiologyand speech-language pathology support personnel; and students in the fields of speech,language, and hearing. Speech-language pathology is the profession that provides clinicalservices and undertakes prevention, advocacy, education, administration, and research in theareas of communication and swallowing across the life span, from infancy through the geriatricstage.Speech-Language Pathology Medical Review Guidelines3
Definition of Speech-Language PathologySpeech-language pathology services are those services necessary for the diagnosis andtreatment of swallowing (dysphagia), speech-language, and cognitive-communication disordersthat result in communication disabilities. Speech-language pathologists treat disorders ofspeech sound production (e.g., articulation, apraxia, dysarthria), resonance (e.g., hypernasality,hyponasality), voice (e.g., phonation quality, pitch, respiration), fluency (e.g., stuttering),language (e.g., comprehension, expression, pragmatics, semantics, syntax), cognition (e.g.,attention, memory, problem solving, executive functioning), and feeding and swallowing (e.g.,oral, pharyngeal, and esophageal stages). (ASHA, 2007a)EtiologiesPotential etiologies of communication and swallowing disorders include: neonatal problems (e.g., prematurity, low birth weight, substance exposure)developmental disabilities (e.g., specific language impairment, autism spectrumdisorder, dyslexia, attention deficit/hyperactive disorder)auditory problems (e.g., hearing loss or deafness, central auditory processing disorders)oral anomalies (e.g., cleft lip/palate, dental malocclusion, macroglossia, oral-motordysfunction)respiratory compromise (e.g., bronchopulmonary dysplasia, chronic obstructivepulmonary disease)pharyngeal anomalies (e.g., upper airway obstruction, velopharyngealinsufficiency/incompetence)laryngeal anomalies (e.g., vocal fold pathology, tracheal stenosis, tracheostomy)neurological disease/dysfunction (e.g., traumatic brain injury, cerebral palsy, cerebralvascular accident, dementia, Parkinson's disease, amyotrophic lateral sclerosis)psychiatric disorder (e.g., psychosis, schizophrenia)genetic disorders (e.g., Down syndrome, fragile X syndrome, Rett syndrome,velocardiofacial syndrome).Further detail is provided in ASHA’s Scope of Practice in Speech-Language Pathology on theASHA Website at t, Diagnosis, Treatment, ReferralSpeech-language pathology services can be grouped into two main categories: 1) diagnostic orevaluative services and 2) therapeutic services. Speech-language treatment is appropriate fordeficits resulting from injury, illness, congenital anomaly, or developmental conditions, and maybe habilitative or rehabilitative in nature.ASHA’s Admission/Discharge Criteria in Speech-Language Pathology (2004a) indicate that“individuals of all ages are eligible for speech-language pathology services when their ability toSpeech-Language Pathology Medical Review Guidelines4
communicate and/or swallow effectively is reduced or impaired or when there is reason tobelieve (e.g., risk factors) that treatment would prevent the development of a speech,language, communication, or feeding and swallowing disorder; reduce the degree ofimpairment; lead to improved functional communication skills and/or functional feeding andswallowing abilities; or prevent the decline of communication and/or swallowing abilities.”Eligibility for services or for evaluation is indicated if one or more of these factors are present:1. Referral from the individual, family member, audiologist, physician, teacher, otherspeech-language pathologist, or interdisciplinary team because of a suspected speech,language, communication, or feeding and swallowing disorder.2. Failure to pass a screening assessment for communication and/or swallowing function.3. The individual is unable to communicate functionally or optimally across environmentsand communication partners.4. The individual is unable to swallow to maintain adequate nutrition, hydration, andpulmonary status and/or the swallow is inadequate for management of oral andpharyngeal saliva accumulations.5. The presence of a communication and/or swallowing disorder has been verified throughan evaluation by an ASHA-certified speech-language pathologist.6. The individual’s communication abilities are not comparable to those of others of thesame chronological age, gender, ethnicity, or cultural and linguistic background.7. The individual’s communication skills negatively affect health, safety, social, emotional,educational, or vocational status.8. The individual’s swallowing skills negatively affect his or her nutritional health or safetystatus.9. The individual, family, and/or guardian seek services to achieve and/or maintain optimalcommunication (including alternative and augmentative means of communication)and/or swallowing skills.10. The individual, family, and/or guardian seek services to enhance communication skills.(ASHA, 2004a)Speech-Language Pathology Medical Review Guidelines5
Speech-Language Pathology ProvidersA speech-language pathologist (SLP) has a master’s or doctoral degree and is licensed, ifapplicable, as a speech-language pathologist by the state in which he or she is practicing. TheSLP possesses a Certificate of Clinical Competence (CCC) from ASHA or has met all theeducational requirements leading to the CCC, and is in the clinical fellowship (CF) year or isotherwise eligible for the CCC.ASHA CertificationThe Certificate of Clinical Competence (CCC) is granted by ASHA in both speech-languagepathology and audiology. It is a nationally recognized credential for the professions. Speechlanguage pathologists and audiologists who possess a graduate degree are eligible to apply forvoluntary certification, which requires the completion of a graduate (master’s or PhD) degree, asupervised clinical fellowship, and a passing score on a national examination. Additionally, thecandidate for certification must acquire the requisite knowledge and skills mandated bycertification standards while enrolled in a program accredited by the Council on AcademicAccreditation in Audiology and Speech-Language Pathology (CAA; ASHA, 2013).Additional certification information is available on ASHA’s website atwww.asha.org/certification/.Clinical DocumentationSpeech-language pathologists prepare, sign, and maintain documentation that describes theprofessional service. Pertinent background information, results and interpretation, prognosis,and recommendations are typically included. Recommendations may include the need forfurther assessment, follow-up, or referral. When intervention is recommended, frequency,estimated duration, and type of service (e.g., individual, group) are typicallyspecified.Documentation includes: findings of the speech-language evaluation objective and subjective measurements of functioning short-term and long-term measurable goals, with expectations for progress expected frequency of t
Speech-Language Pathology Medical Review Guidelines 3 Introduction The purpose of the medical review guidelines for speech-language pathology is to serve as a resource for health plans to use in all facets of claims review and policy development. The guidelines provide an overview of the profession of speech-language pathology including
SPEECH-LANGUAGE PATHOLOGY LICENSING GUIDE LICENSURE REQUIREMENTS CHECKLIST (Listed below are the minimum requirements needed to obtain licensure in the Speech-Language Pathology field.) APPLICATION AND FEES Application for a Speech-Language Pathology License - Complete all fields, answer all questions and
3. To provide clinical services in audiology and speech/language pathology. The information in this clinic handbook includes policies and procedures related to clinical education in speech-language pathology. Each student enrolled in the speech-language pathology program is responsible for the information contained herein.
Vista Pathology Laboratory – User’s Guide 1 Who We Are Reedy, Michael MD Pathology Nixon, Randal MD, PhD Pathology Neuropathology Loudermilk, Allison MD Pathology Hematopathology Wu, Bryan MD Pathology Breast Pathology Dermatopathology Pike, Robin MD Pathology Cy
Speech-Language Pathology Assistant (3003)- 130.00 Audiology Assistant (3004)- 130.00 Application for Speech-Language Pathology or Audiology Assistant Certification Board of Speech-Language Pathology & Audiology P.O. Box 6330 Tallahassee, FL 32314-6330 Fax: (850) 245-4161 Email: info@floridasspeechaudiology.gov Do Not Write in this Space
Language Pathology (CAA) of the American Speech-Language-Hearing Association. This is a “pre-accreditation” status with the AA, awarded to developing or emerging programs for a maximum period of five years. Council on Academic Accreditation in Audiology and Speech-Language Pathology American Speech-Language Hearing Association
The purpose of the East Tennessee State University Speech-Language-Hearing Clinic is twofold: first, to provide training to students majoring in speech-language pathology and audiology; and second, to provide professional services to members of the general public and university community with speech, language, and/or hearing problems.
practice of speech-language pathology in the schools and a master's requirement for all other speech-language pathologists. 5. Make standards for practice of speech-language pathology consistent with those for practice in the "sister" profession of audiology. 6. Have little impact on the number of available personnel in speech-language pathology.
Introduction to Literary Criticism. Definition and Use “Literary criticism” is the name given to works written by experts who critique—analyze—an author’s work. It does NOT mean “to criticize” as in complain or disapprove. Literary criticism is often referred to as a “secondary source”. Literary Criticism and Theory Any piece of text can be read with a number of different .
