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Evicore Speech Therapy Guidelines CLINICAL GUIDELINES Speech Therapy Version 1.0 Effective February 14, 2020 Clinical guidelines for medical necessity review of speech therapy services. © 2019 eviCore healthcare. All rights reserved. Musculoskeletal Benefit Management Program: Speech Therapy Guidelines V1.0 Please note the following: CPT Copyright 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. ______________________________________________________________________________________________________ ©2019 eviCore healthcare. All Rights Reserved. Page 2 of 233 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Musculoskeletal Benefit Management Program: Speech Therapy Guidelines V1.0 Speech Therapy Guidelines ST-1: Utilization Management Policy Speech Language Pathology 4 ST-2: Section Intentionally Left Blank 16 ST-3: Section Intentionally Left Blank 17 ST-4: Aphasia 18 ST-5: Acquired Apraxia of Speech 27 ST-6: Apraxia: Pediatrics 34 ST-7: Augmentative and Alternative Communication (AAC) 42 ST-8: Autism Spectrum Disorder 53 ST-9: Bilingual Service Criteria 70 ST-10: (Central) Auditory Processing Disorder (C)APD 81 ST-11: Cognitive Communication Disorders: Adult and Pediatric 93 ST-12: Dysarthria 109 ST-13: Dysphagia (Swallowing Disorder) - Adults 116 ST-14: Dysphagia (Swallowing Disorder) - Pediatrics 128 ST-15: Feeding Aversion 136 ST-16: Fluency Disorder 149 ST-17: Hearing Loss and Aural Rehabilitation 157 ST-18: Hearing Screening 170 ST-19: Section Intentionally Left Blank 175 ST-20: Orofacial Myofunctional Disorders 176 ST-21: Selective Mutism 182 ST-22: Speech Sound Disorders: Articulation and Phonology 189 ST-23: Spoken Language Disorders: Pediatrics 202 ST-24: Voice Disorders 212 ST-25: Written Language - Disorders: Pediatrics 222 ______________________________________________________________________________________________________ ©2019 eviCore healthcare. All Rights Reserved. Page 3 of 233 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Musculoskeletal Benefit Management Program: Speech Therapy Guidelines V1.0 ST-1: Utilization Management Policy Speech Language Pathology ST-1.1: Section Intentionally Left Blank ST-1.2: Definitions ST-1.3: Care Classifications ST-1.4: Criteria/Guidelines for Provision of Speech Therapy (ST) ST-1.5: Authorization of Services ST-1.6: Applicable Federal and State Mandates ST-1.7: eviCore’s Evidence Based Guidelines ______________________________________________________________________________________________________ ©2019 eviCore healthcare. All Rights Reserved. Page 4 of 233 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Musculoskeletal Benefit Management Program: Speech Therapy Guidelines V1.0 Purpose This policy outlines the process for determining medically necessary, appropriate and reasonable speech therapy services. ST-1.1: Section Intentionally Left Blank ST-1.2: Definitions Utilization Management The Institute of Medicine (IOM) Committee on Utilization Management by Third Parties recognizes UM as "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision." There are 3 types of Utilization Management: Precertification/prior authorization is conducted before a service or treatment and is rendered in order to eliminate or reduce unnecessary services. Concurrent reviews performed during the episode of care. Periodic review occurs at varied intervals and may encompass case management activities such as care coordination, discharge planning, and care transitioning. Retrospective review is conducted after the service has been completed and assesses the appropriateness of care provided. Speech Therapy Speech therapy is the treatment of speech/language production, voice production, swallowing function, cognitive-linguistic skills, and/or general communication abilities that have been impaired as a result of a disease, injury, developmental delay or surgical procedure. The purpose of speech therapy is to provide necessary services for the diagnosis and treatment of impairments, functional limitations, disabilities or changes in speech/language production, voice production, swallowing function, cognitive-linguistic skills, general communication deficits, and compensatory communication abilities. Speech therapy is medically necessary to help restore functional speech, swallowing and language following the onset of their impairment. Medically Necessary Services To be considered reasonable and necessary the following conditions must each be met: Services are for the treatment of a covered injury, illness or disease, and are appropriate treatment for the condition Treatments are expected to result in significant, functional improvement in a reasonable and generally predictable period of time, or are necessary for the establishment of a safe and effective maintenance program. Treatment should be directed toward restoration or compensation for lost function. The improvement potential must be significant in relation to the extent and duration of the therapy required Speech Language Pathology ______________________________________________________________________________________________________ ©2019 eviCore healthcare. All Rights Reserved. Page 5 of 233 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Musculoskeletal Benefit Management Program: Speech Therapy Guidelines V1.0 The services must be currently accepted standards of medical practice, and be specific and effective treatments for the patient’s existing condition The complexity of the therapy and the patient’s condition must require the judgment and knowledge of a licensed qualified clinician practicing within the scope of practice for that service. Services that do not require the performance or supervision of a qualified clinician are not skilled and are not considered reasonable or necessary therapy services, even if they are performed or supervised by a qualified professional. The amount, frequency, and duration of the services must be reasonable under accepted standards of practice. Services shall be of such a level of complexity and sophistication or the condition of the patient shall be such that the services required can be safely and effectively performed only by a therapist, or in the case of physical therapy and occupational therapy by or under the supervision of a therapist. Services that do not require the performance or supervision of a therapist are not skilled and are not considered reasonable or necessary therapy services, even if they are performed or supervised by a qualified professional. For these purposes, “generally acceptable standards of practice” means standards that are based on credible scientific evidence published in the peer-reviewed literature generally recognized by the relevant healthcare community, specialty society evidence- based guidelines or recommendation, or expert clinical consensus in the relevant clinical areas. ST-1.3: Care Classifications Therapeutic Care Therapeutic care is care provided to relieve the functional loss associated with an injury or condition and is necessary to return the patients to the functioning level required to perform their daily needs and work activities. Speech and language disorders and swallowing problems (dysphagia) tend to have periods of plateau followed by functional improvements. In addition, the symptoms will change over time. Therefore, discharge planning will consider when further treatment is expected to provide little or no measurable improvement for the condition being treated, or when symptoms have resolved or maximum potential has been met and/or a plateau has been reached maximum potential achieved and the individual patient/family circumstances. Therapeutic care generally occurs within a reasonable period of time and is guided by evidence based practice of speech therapy. Early Stage Treatment Explore factors that could impact outcomes now and in the future. Explore strengths and weaknesses, and other components for best treatment outcomes. Explore patient and family understanding, challenges and capabilities to develop education and training programs. Develop a treatment program based on findings and best practices. Speech Language Pathology ______________________________________________________________________________________________________ ©2019 eviCore healthcare. All Rights Reserved. Page 6 of 233 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Musculoskeletal Benefit Management Program: Speech Therapy Guidelines V1.0 Develop an individualized supplemental home program to monitor and change as needed. Ongoing Treatment Provide patient/family ongoing education and training Assess response to and feedback from home program to modify, and update as needed Assess ongoing response to treatment, gains, lack of progress, and other factors; modify program as needed Determine other factors impacting condition requiring intervention or referral. Later Stage of Treatment/Discharge Planning Provide suggestions and resources for follow-up. Provide home program to maintain gains. If discharge is due to medical issues, and or a plateau in progress, indicate under what future conditions a new referral would be warranted. Palliative Care (Non-covered
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