SPEECH & LANGUAGE BENEFITS CHECK SUGGESTIONS
As a reminder, Moore Speech & Language is not in-network with insurance and payment is due directly from you at the time of service. You may be able to seek reimbursement through your insurance company using your out-of-network benefits. You will typically pay more for services provided by an out-of-network provider. If you wish to use your in-network benefits, it is recommended that you contact your primary care provider for a referral.
To learn more about your out-of-network benefits, call the customer service phone number on your insurance card and follow the prompts to reach the Eligibility/Benefits Customer Service Department.
Make note of the representative you speak to and the date and time of your call.
Questions may include the following:
Does my plan offer out-of-network benefits for speech therapy? (see below for possible procedure and diagnosis codes)
Is teletherapy a covered service?
Will I have a co-pay or co-insurance? Are benefits subject to a deductible? What is the out-of-network deductible? Is it separate from our in-network deductible? How much of our out-of-network deductible have we met so far this year?
Is there a yearly benefits limit? Is this benefit combined with other therapy services (e.g. occupational therapy, chiropractic, physical therapy)?
Once met, what is the usual and customary reimbursement amount (the allowable) for the procedure being billed? Your insurance company will only pay towards their allowed amount which may be less than the billed amount.
Are there policy exclusions for speech therapy benefits? Be aware that plans may exclude specific diagnosis codes such as developmental codes starting with an “F”, or may provide coverage only for injury, illness, or congenital anomalies).
Is preauthorization required for evaluation and/or speech therapy? If preauthorization is required, what is the process for getting it?
Is a physician referral required?
What paperwork/information will I need to provide to my insurance company for reimbursement?
How and where do I submit claims? What is the time period between submission and reimbursement?
You may need to provide the insurance company with the procedure (CPT code) to determine if specific services are covered. Common CPT procedure codes include the following:
SLP evaluations:
92521 (stuttering/fluency evaluation)
92522 (speech evaluation)
92523 (speech and language evaluation)
92610 (feeding evaluation)
SLP therapy/treatment:
92507 (individual speech/language therapy)
92508 (group therapy)
92526 (feeding therapy)
Parent/caregiver training without client present (as part of a plan of care that also includes direct client services)
97550 (first 30 minutes) 97551 (each additional 15 minutes)
You may also be asked for a diagnosis (ICD-10) code. If your child doesn’t yet have a diagnosis, it will be determined during the initial evaluation. Common diagnosis codes include F80.0 (speech articulation disorder), F80.2 (mixed expressive/receptive language disorder), and F80.82 (pragmatic language disorder). If your child already has an Autism Spectrum Disorder diagnosis (F84.0), it is usually billed in conjunction with R48.8 (Other symbolic dysfunction/communication challenges secondary to another disorder). An ASD diagnosis may changes how benefits are paid, visit limits, what is covered, and whether preauthorization is required.