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Insurance Coverage of Speech Pathology Services: What Parents Need to Know

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—This 30 slide presentation provides basic information regarding insurance coverage for common outpatient speech language assessment and therapy services. ——It contains important questions parents must ask when speaking to their insurance representatives regarding service coverage. —It provides common ICD-9 and ICD-10 pediatric diagnostic codes, lists common SLP-based therapeutic (CPT) codes and discusses common service exclusions in private large insurance policies. —It also provides some suggestions on how to initiate appeals for denial of services and includes links to helpful resources parents can access to obtain further elaboration on the information provided in this presentation.
Intended Audience:
  • —Parents
  • —Caregivers
  • —Speech Language Pathologists (SLPs)
    • —New Graduates
    • —Clinical Fellows
    • —Private Practitioners
  • —SLPs may forward this presentation to the parents seeking clarification on reimbursement questions


—The  information in this presentation was gathered on the East Coast and is applicable primarily to the states located in that area.
—This information is by no means an exhaustive treatise but is meant to serve as a very general guideline for parents seeking more information regarding speech therapy insurance reimbursement
Slide Content:
  • Overview of therapy services provided by the state
  • Who does NOT Qualify for Early Intervention Services
  • Supplemental speech language services
  • Initiating Assessment
  • Say NO to Assumptions
  • Calling the insurance company
  • Therapy Coverage
  • What do the major companies pay for?
  • Specifying exclusions directly in the contract
  • Lack specification and …coverage
  • Questions to ask your insurance
  • DSM-5 Changes SLP-Relevant Disorder Categories
  • DSM-5 and ICD-10 Changes
  • Divergent Coding in DSM-5
  • Common Pediatric Speech Language Codes
    • Contains Codes Conversion from ICD-9 CM to ICD-10CM
  • 2015 Therapy Treatment (CPT) Codes 
  • Intellectual Disabilities and Syndrome Codes
  • Autism Codes
  • Speech Language Services and Autism
  • States with Mental Health Parity for Autism
  • States with no Autism Therapy Coverage
  • Speech Language Services and Autism (New Jersey)
  • Denials and Appeals
  • Helpful Resources
    • Highlighted Links
      • —ICD-9-CM to ICD-10-CM Free Conversion Tool
      • —2015 ICD-10-CM Diagnosis Codes Related to Speech, Language, and Swallowing Disorder (ASHA)


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