If you or your loved one has trouble reading, writing, understanding spoken language, speaking, or swallowing, you may need help from a speech language pathologist (SLP). Language difficulties arise out of a variety of health problems, including strokes, head trauma, cancer, Parkinson’s, Alzheimer’s, multiple sclerosis, and amyotrophic lateral sclerosis (ALS). It only makes sense then that the services provided by SLPs are equally diverse. Among these services is speech therapy. Medicare can help pay the cost for speech therapy, making the process of helping you or your loved one communicate less financially demanding.
Anyone with Part B Medical Insurance can have medically necessary outpatient SLP therapy costs covered, to a certain extent. As of 2016, there are “therapy cap limits” for both speech therapy and physical therapy. Once the combined cost for both therapies exceeds $1,950 Medicare stops paying. This can pose a problem if your condition causes both language and mobility issues (as with a stroke or Parkinson’s).
Until you hit the cap, you will generally pay 20% of the Medicare-approved amount for your medical service. Your deductible, coinsurance, and what Medicare covers for your medical care all can contribute to the $1,950 therapy cap. You should speak with your SLP about what your specific item or service will cost. Medicare-covered therapies may include:
- Voice production
- Auditory training
- Speech reading
- Reading comprehension training
- Education and counseling on communication strategies
- Oral and writing rehabilitation
- Treatments for dysphasia (difficulty swallowing)
As with all Medicare coverage, you should get services from a doctor who agrees to be paid for their service directly by Medicare. Understand that your costs may change depending on your location and medical facility.
Petitioning for more services
Even after you hit the $1,950 therapy cap, you still have options to get Medicare to pay for your speech therapy. If you need to petition for an exception to the therapy cap limit, your SLP must first document the medical necessity of your continued treatment in your medical record. Next, they must indicate this information on your Medicare claim. After this is completed successfully, Medicare should continue to cover 80% of therapy costs for an additional $3,700. When your outpatient therapy exceeds this $3,700 threshold, then a Medicare contractor may review your medical records, checking for medical necessity. If any part of your therapy isn’t medically necessary, your SLP should give you a notice called the “Advance Beneficiary Notice of Noncoverage.” This notice lets you choose whether to have therapy that isn’t covered by Medicare.
Who is administering your speech therapy matters a great deal for Medicare coverage. Medicare will only cover your speech therapy administered by a qualified speech-language pathologist. They must be either certified by the American Speech-Language Hearing Association or obtaining supervised experience for that certification. Medicare will not cover therapy administered by a language pathology assistant (even if they’re licensed in their state) because they provide what Medicare considers unskilled medical service. Similarly, any speech therapy services you get from an aid (even if supervised by a SLP) will be considered unskilled services and not covered by Medicare