Insurance Information

Let's Get Insurance Done Right.

We compiled a list of resources, and answers to some of the most common questions regarding insurance applied to your treatments.

DAYLINDA RADLEYMA, CCC-SLP

Knowing Your Insurance Plan

The first step is to call your insurance company and ask them what documentation is required to get assessment coverage. Depending on your insurance company, responses might vary. Some insurance companies require a written prescription from the doctor coupled with the precertification interview with the treating speech therapist. Typically, the utilization management section of the insurance company deals with the precertification interview (may be referred to as prior authorization or medical review depending on the insurance company.

After precertification takes place, make sure to ask your insurance representative regarding the coverage for out of network therapists. They will instead provide you with a letter for your insurance company, containing the necessary diagnosis and treatment codes, incurred fees as well as a brief description of services provided, and will expect you to apply for reimbursement on your own.

ALL CLIENTS are strongly recommended to complete the steps above to understand and know their insurance plans so as to prepare appropriately and avoid any confusion as well as costly errors. Just asking if you are covered for “speech” therapy is not enough to determine if you are covered for the specific treatment you need.

Therefore, when asking about coverage, you should also ask about specific diagnostic and procedure codes. Below is a list of the most common codes below. We are happy to help assist with identifying the best or most appropriate codes after our consultation.

Common Procedures and Diagnosis Codes for Speech & Language Therapy

Note: These are some of the more common procedures and not a comprehensive list of procedures and diagnosis codes; refer to your initial evaluation report and treatment plan for detailed informa

Evaluation (CPT):

92521 Evaluation of speech fluency (eg, stuttering, cluttering)
92522 Evaluation of speech sound production (eg., articulation, phonological process, apraxia, dysarthria)
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) with evaluation of language comprehension and expression (eg, receptive and expressive language)

Therapy (CPT):

92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder, individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder, group
92609 Therapeutic services for the use of speech-generating device, including programming and modification 97532 Development of cognitive skills to improve attention, memory, problem solving

Possible Diagnosis (ICD-10):

F84.0 Autistic Disorder
F80.81 Stuttering
F80.1 Expressive Language Disorder
F80.2 Mixed Expressive Receptive Language Disorder
F80.0 Phonological Disorder
R48.9 Other symbolic dysfunction
F80.9 Cognitive Communication Disorder
R47.81 Slurred Speech
R47.02 Dysphasia

Sample Talking Points when Talking with Insurance

SPEECH THERAPY
Date:
Time:
Name of Representative:
Reference # ___________

My child is ____old. Does our policy cover his speech services?
What conditions will insurance specifically cover?
What ICD-10 (diagnosis) codes and CPT (treatment) codes are covered for reimbursement? See codes below.
Do I need to obtain a prescription for therapy services?
Do I need to obtain precertification for therapy services?
Which conditions are specifically excluded from treatment?
How many sessions will insurance cover? Is there a time limit?
Do I have a deductible or co-pay?
Do I need to schedule all of the visits by a certain date?
Does insurance cover out of network therapy services?
How do I get reimbursed for out of pocket therapy expenses? What do I need to provide the insurance
company with?

Your Rights and Protection Against Surprise Medical Bills

When you see a health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn’t in your health plan’s network. “Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.”

This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit. “Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

Good Faith Estimate:
For uninsured or self-pay patients, we are happy to provide good faith estimates of costs for services to assist with understanding and preparing for the potential costs before receiving speech therapy evaluation and treatment.