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CodeMap® LCD-L34429

 

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L34429
LCD for Outpatient Speech Language Pathology (L34429)
See related Articles:
A56868-Billing and Coding: Outpatient Speech Language Pathology

Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor

Contractor Number: 11201

Contractor Type: MAC A

LCD Information

LCD ID Number: L34429 Status: A-Approved

LCD Title: Outpatient Speech Language Pathology

Geographic Jurisdiction: South Carolina Other Jurisdictions

Original Determination Effective Date: 10/01/2015

Original Determination Ending Date:

Revision Effective Date: 11/11/2021

Revision End Date:

CMS National Coverage Policy:

Title XVIII of the Social Security Act, §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act, §1862(a)(7) excludes routine physical examinations.

Title XVIII of the Social Security Act, §1835(2)(D) lists requirements for certification and recertification of outpatient speech pathology services.

42 Code of Federal Regulations (CFR) §410.61 Plan of treatment requirements for outpatient rehabilitation services

42 Code of Federal Regulations (CFR) §424.24 Requirements for medical and other health services furnished by providers under Medicare Part B

42 Code of Federal Regulations (CFR) §485.705 Personnel qualifications

42 Code of Federal Regulations (CFR) §485.715 Condition of participation: Speech pathology services

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, §20.4.1 Diagnostic Services Defined

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 7, §40.2.1 General Principles Governing Reasonable and Necessary Physical Therapy, Speech-Language Pathology Services, and Occupational Therapy and §40.2.3 Application of the General Principles to Speech-Language Pathology Services

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 8, §30.4 Direct Skilled Therapy Services to Patients and §30.4.1.2E Application of Guidelines: Maintenance Therapy

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 12, §10 Comprehensive Outpatient Rehabilitation Facility (CORF) Services Provided by Medicare, §20 Required and Optional CORF Services, §20.2 Optional CORF Services and §40.4 Speech Language Pathology Services

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.3 Audiology Services, §220.1.1 Care of a Physician/Nonphysician Practitioner (NPP), §220.1.2 Plans of Care for Outpatient Physical Therapy, Occupational Therapy, or Speech-Language Pathology Services, §220.1.3 Certification and Recertification of Need for Treatment and Therapy Plans of Care, §220.1.4 Requirement That Services Be Furnished on an Outpatient Basis, §220.2 Reasonable and Necessary Outpatient Rehabilitation Therapy Services, §220.3 Documentation Requirements for Therapy Services, §230 Practice of Physical Therapy, Occupational Therapy and Speech-Language Pathology, §230.3 Practice of Speech-Language Pathology, §230.5 Physical Therapy, Occupational Therapy and Speech-Language Pathology Services Provided Incident to the Services of Physicians and Non-Physician Practitioners (NPP) and §230.6 Therapy Services Furnished Under Arrangements With Providers and Clinics

CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 1, §50.1 Speech Generating Devices, §50.2 Electronic Speech Aids, §50.3 Cochlear Implantation and §50.4 Tracheostomy Speaking Valve

CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 3, §170.1 Institutional and Home Care Patient Education Programs, §170.2 Melodic Intonation Therapy and §170.3 Speech-Language Pathology Services for the Treatment of Dysphagia

CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 3, §3.3.2.4 Signature Requirements

CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 13, §13.5.1 General Requirements

CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Transmittal 179, dated January 14, 2014, Change Request 8458


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12/01/2022 03:03:57 34.239.154.240


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