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Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor Contractor Number: 10211 Contractor Type: MAC A

LCD Information

LCD ID Number: L34429 Status: A-Approved LCD Title: Outpatient Speech Language Pathology Geographic Jurisdiction: Georgia Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 12/08/2022 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 CFR §410.61 Plan of treatment requirements for outpatient rehabilitation services 42 CFR §424.24 Requirements for medical and other health services furnished by providers under Medicare Part B 42 CFR §485.705 Personnel qualifications 42 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 Sorry, you need to login or register to view additional sections of this Medicare policy. *