LCD ID Number: L35070 Status: A-Approved
LCD Title: Speech - Language Pathology (SLP) Services: Communication Disorders
Geographic Jurisdiction: Maryland Other Jurisdictions
Original Determination Effective Date:
Original Determination Ending Date:
Revision Effective Date:
Revision End Date:
CMS National Coverage Policy:
This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for speech/language services. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for speech/language services and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site.
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual,
- Chapter 8 Coverage of Extended Care (SNF) Services Under Hospital Insurance
- Chapter 12 Comprehensive Outpatient Rehabilitation Facility (CORF) Coverage
- Chapter 15, Covered Medical and Other Health Services, Section 220 Coverage of Outpatient Rehabilitation Therapy Services (Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services) Under Medical Insurance and Section 230 Practice of Physical Therapy, Occupational Therapy, and Speech-Language Pathology
- CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Part 3, Section 170.2 Melodic Intonation Therapy
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 5, Part B Outpatient Rehabilitation and CORF/OPT Services
- CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Local Coverage Determinations, Section 13.5.4 Reasonable and Necessary Provision in an LCD
Social Security Act (Title XVIII) Standard References:
- Title XVIII of the Social Security Act, Section 1835(2)(D) outlines requirements for outpatient speech pathology services including certification and recertification of the plan of care.
- Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.
- Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.
Code of Federal Regulations (CFR) References:
- CFR, Title 42, Section 409.32 Criteria for skilled services and the need for skilled services
- CFR, Title 42, Section 410.61 Plan of treatment requirements for outpatient rehabilitation services
- CFR, Title 42, Section 424.24(c) Requirements for medical and other health services furnished by providers under Medicare Part B
- CFR, Title 42, Section 485.705 Personnel Qualifications
- CFR, Title 42, Section 485.715 Condition of participation: Speech pathology services
- Jimmo Settlement information located at www.CMS.gov/Center/Special-Topic/Jimmo-Center.html
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06/07/2023 03:32:26 188.8.131.52