Does Medicare Cover Speech Pathology?
This article was updated on: 09/12/2018
The National Institute on Deafness and Other Communication Disorders estimates that between 6 million and 8 million people in the U.S. suffer from some form of language impairment. Among adults, many of these language disorders are caused by dementia, head injury, stroke, or even brain tumor.
If you or someone you love has a language impairment, your doctor may recommend speech and language therapy. As a Medicare beneficiary, here’s what you should know about Medicare coverage of speech therapy.
What is speech and language therapy?
Speech and language therapy is typically provided by a speech-language therapist also known as Speech-Language Pathologist (SLP). The American Speech-Language and Hearing Association (ASHA) describes a speech and language therapy professional as someone who can:
- Assess, diagnose, and treat disorders that affect swallowing, language, and communication disorders in both children and adults.
- Work to prevent these disorders among vulnerable individuals.
- Provide rehabilitation services for those who lose their hearing.
- Teach augmentative and alternative communication (AAC) techniques to individuals who are unable to express themselves with speech.
- Provide counseling services to those affected by speech pathology disorders.
According to ASHA, professionals who provide speech and language therapy must earn a master’s degree, complete the required number of hours of clinical experience, and pass a national licensure exam.
What happens during speech and language therapy?
Aphasia is the medical term for communication problems that affect your ability to express yourself clearly, understand words spoken to you by others, or even read and write, according to the National Stroke Association. According to ASHA, stroke is the most common cause of aphasia, although brain tumors, traumatic brain injury, and neurological disorders such as dementia may also cause the condition.
Aphasia is treatable, most often by speech and language therapy, according to the National Stroke Association. If you get speech therapy to help you recover from aphasia, you may have one or more of the following types of speech therapy, depending on the nature and severity of your condition:
- Melodic intonation therapy, which helps people “sing” words they have trouble speaking.
- Art therapy.
- Visual speech perception exercises to help you associate words with pictures.
- Group speech and language therapy.
In some cases, you may be prescribed medication to help treat your speech pathology.
Your therapist may also ask you to “practice” at home by playing word games, cooking from a new recipe, singing and reading aloud, or writing shopping lists or greeting cards.
Does Medicare cover speech therapy?
If you get your speech and language therapy in an outpatient setting, Medicare Part B may cover allowable charges for medically necessary speech therapy. You are responsible for 20% of the allowable charges and your Part B deductible applies.
Note, however, that there is an annual limit, or “therapy cap,” to the amount Medicare will pay for your speech therapy. If your doctor believes that additional speech therapy is necessary to help you recover, he or she may request an exception to the therapy cap. To qualify, your health care provider must make the case that the additional speech therapy is medically needed and must note this in your medical record. The exception must also be noted on the claim your provider sends to Medicare for your speech pathology services.
If you are approved for an exception, Part B will generally continue to pay 80% of allowable charges for as long as your provider continues to document that the care is medically necessary.
If you are referred for speech therapy services at home, your treatment may be covered under Part A. In order to qualify for coverage, you must meet all of the following conditions:
- You must be under a doctor’s care and he or she must write a care plan that includes speech pathology treatment, and review and update it at established intervals.
- Your doctor believes your condition will be improved within a reasonable period of time with speech and language therapy.
- Your doctor must certify that you are homebound.
- The agency you use to provide speech pathology services must be certified by Medicare.
If you qualify for home speech and language therapy, you generally pay nothing for those services.
Need more information on Medicare and speech and language therapy?
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