Medicaid Benefits: Services for Speech, Hearing and Language Disorders
This data is presented as an interactive tool that allows users to: filter by timeframe/year, select specific data columns (distributions), filter by state or geography, and view the data as a table, map, or trend chart.
2018
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limits on Services | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 37 No - 9 NR - 5 | 2018 data limited to CN | Yes - 12 | Yes - 21 | Included in "Limits on Services" for 2018 | Not included in 2018 survey |
| Alabama | No | - | - | |||
| Alaska | No | - | - | |||
| Arizona | Yes | CN | $3.00 per visit for beneficiaries with Transitional Medical Assistance | Limited to inpatient or ALTCS | - | - |
| Arkansas | Yes | CN | NR | NR | - | - |
| California | Yes | CN | $1 per outpatient visit | Coverage limited to pregnant or institutionalized adults, physician order required. | - | - |
| Colorado | Yes | CN | No | No | - | - |
| Connecticut | No | - | - | |||
| Delaware | Yes | CN | No | in home or office and renewed by physician every 30 days services must be reasonable and necessary | - | - |
| District of Columbia | Yes | CN | No | Requires PA for service to be reimbursable | - | - |
| Florida | Yes | CN | No | $1500 max per year for outpatient services, as specified on the outpatient revenue code listing | - | - |
| Georgia | No | - | - | |||
| Hawaii | Yes | CN | No | No | - | - |
| Idaho | Yes | CN | No | No | - | - |
| Illinois | NR | NR | NR | NR | - | - |
| Indiana | Yes | CN | No | Prior authorization required unless ordered by physician prior to hospital discharge. 1 audiological testing and evaluation/3 years. 30 therapy sessions/month in combination with other therapy providers. | - | - |
| Iowa | NR | NR | NR | NR | - | - |
| Kansas | Yes | CN | $1.00 per service date | No | - | - |
| Kentucky | Yes | CN | $3 | Annual limit of 20 visits | - | - |
| Louisiana | Yes | CN | No | Services require prior authorization | - | - |
| Maine | Yes | CN | $.50 to $2/day depending on payment amount, up to $20/month | No | - | - |
| Maryland | No | - | - | |||
| Massachusetts | Yes | CN | No | No | - | - |
| Michigan | Yes | CN | No | Speech services may be provided up to a maximum of 36 times during 12 consecutive calendar months without PA. Each encounter must represent a minimum of 25 minutes of therapy provided on the date of service. | - | - |
| Minnesota | Yes | CN | NR | No | - | - |
| Mississippi | Yes | CN | No | NR | - | - |
| Missouri | No | - | - | |||
| Montana | Yes | CN | Income at or below 100% FPL - $4 per visit; above FPL - 10% of payment amount | No | - | - |
| Nebraska | Yes | CN | $2 per session for ST evaluation | a combined total of 60 therapy sessions per fiscal year (physical therapy, occupational therapy, speech therapy) | - | - |
| Nevada | NR | NR | NR | NR | - | - |
| New Hampshire | Yes | CN | No | NR | - | - |
| New Jersey | Yes | CN | No | No | - | - |
| New Mexico | Yes | CN | $7 for WDI recipients | No | - | - |
| New York | NR | NR | NR | NR | - | - |
| North Carolina | Yes | CN | No | Prior approval is required to verify medical necessity and treatment visits are limited per calendar year. | - | - |
| North Dakota | Yes | CN | $1 per visit | 1 evaluation per year 30 visits per year | - | - |
| Ohio | Yes | CN | No | 30 visits per benefit year without PA. | - | - |
| Oklahoma | Yes | CN | $4 per visit | one evaluation/re-evaluation visit per calendar year; limited to 15 visits per calendar year in an outpatient hospital | - | - |
| Oregon | Yes | CN | No | Day limits. All coverage is based upon the prioritized list of health services. | - | - |
| Pennsylvania | No | - | - | |||
| Rhode Island | Yes | CN | No | No | - | - |
| South Carolina | NR | NR | NR | NR | - | - |
| South Dakota | Yes | CN | No | NR | - | - |
| Tennessee | Yes | CN | No | No | - | - |
| Texas | No | - | - | |||
| Utah | Yes | CN | $4 per visit | Limited to evaluation, diagnosis and therapy to treat disorders related to traumatic brain injuries, cerebrovascular accidents, and disabilities which qualify members to receive speech-generating devices and to treat swallowing dysfunction; 1 speech evaluation per year | - | - |
| Vermont | Yes | CN | No | 30 visits per year in combination with physical therapy and occupational therapy; physician order required; additional services require prior authorization | - | - |
| Virginia | No | - | - | |||
| Washington | Yes | CN | No | limit of 12 units per year, more with PA | - | - |
| West Virginia | Yes | CN | No | For members 21 years of age and over, limited services such as augmentative communication(AC)/speech generating systems, artificial larynx, tracheostomy speaking valves, speech therapy, and function tests for specific medical conditions are covered | - | - |
| Wisconsin | Yes | CN | $0.50 - $3.00 per service; no copay after the first 30 hours of service or $1,500, whichever occurs first, per calendar year | Prior approval required after 35 visits - evaluations do not count towards the 35 visits; Services limited to 90 minutes per date of service | - | - |
| Wyoming | Yes | CN | No | Prior authorization is required after the first 20 visits to confirm ongoing medical necessity | - | - |
2012
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 40 No - 16 | Yes - 14 No - 26 | ||||
| Alabama | No | |||||
| Alaska | Yes | CN | Fee for service at 85% of physician fee | |||
| American Samoa | Yes | See territory-specific FN | Diagnostic speech and audiological evaluations covered only through LBJ Tropical Medical Center when necessary | |||
| Arizona | Yes | CN & MN | $2.30/service | Outpatient services limited to ALTCS members | Yes | Fee for service |
| Arkansas | No | |||||
| California | Yes | CN & MN | $1/visit | Coverage limited to pregnant or institutionalized adults, physician order required, limited to 2 services per month in combination with services by selected other practitioners | Services after initial 6-month evaluation | Fee for service |
| Colorado | Yes | CN | 5 SP units/day, audiology procedures limited to specified conditions | Fee for service | ||
| Connecticut | No | |||||
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | No | |||||
| Florida | Yes | CN & MN | Limited to services for provision of augmentative and assistive communication systems | Fee for service | ||
| Georgia | No | |||||
| Guam | Yes | CN | Limited to audiological services and diagnostic testing for speech and language disorders | Fee for service using Medicare fee schedule | ||
| Hawaii | Yes | CN & MN | Yes | Fee for service | ||
| Idaho | Yes | CN | $3.65/visit up to 5% of income/year across all services | 40 sessions speech pathology services/year up to a maximum of $1,870 in payments/year in combination with physical therapy services, audiology services not covered | Fee for service | |
| Illinois | Yes | CN & MN | 20 visits/year | Yes | Fee for service or certified cost | |
| Indiana | Yes | CN | 1 audiological testing and evaluation/3 years, 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge | Yes, unless ordered by physician prior to hospital discharge | Fee for service | |
| Iowa | Yes | CN & MN | $2/day | Hearing services limited to audiologists, speech language services limited to speech language pathologists if not in rehab agency or outpatient hospital | Fee for service | |
| Kansas | Yes | CN & MN | $3/service | Treatment limited to 6 months/year, SP for post-trauma or illness only, physician order and rehab potential required, specified limits regarding audiological testing and evaluation | Fee for service | |
| Kentucky | No | |||||
| Louisiana | No | |||||
| Maine | Yes | CN & MN | $.50-$2/day for SP services, depending on payment, up to $20/month | Decline in oral communication or ability to chew or swallow must be demonstrated, rehab potential required | Fee for service | |
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | 35 SP visits/year | Fee for service | ||
| Michigan | Yes | CN & MN | Yes | Fee for service | ||
| Minnesota | Yes | A & B - See state-specific FN | $3/visit for non-preventive service visit with audiologist | Fee for service | ||
| Mississippi | No | |||||
| Missouri | Yes | CN | Adult coverage limited to those who are pregnant, blind or residing in nursing facilities | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $3/SP visit, $2/visit audiology service | A - 40 hours/year, B - limited to services essential for employment | Fee for service | |
| Nebraska | Yes | CN & MN | $2 or $3/specified services - see state-specific FN | 60 visits/year in combination with other therapies, rehab potential required | Fee for service | |
| Nevada | Yes | CN | Rehab potential required, audiological testing and evaluation requires physician order | Yes | Fee for service | |
| New Hampshire | Yes | CN & MN | Eighty 15-minute time units/year included in limits with OT and PT providers | Fee for service | ||
| New Jersey | No | |||||
| New Mexico | Yes | CN | A - $0-$7/visit depending on income, B - $7/visit - see state-specific FN | Audiological testing and evaluation require physician order; A - limited to short-term treatment up to 60 days per condition but may be extended for additional 60 days with prior approval | Yes | Fee for service |
| New York | Yes | CN & MN | 20 visits/year - persons with developmental disabilities or acquired brain injuries exempt from limit | Fee for service | ||
| North Carolina | No | |||||
| North Dakota | Yes | CN & MN | $1/SP visit, $2/audiological evaluation | 1 speech evaluation/year, 30 therapy visits/year | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | ||||
| Ohio | Yes | CN | 30 dates of service/year in non-institutional setting | Specified services | Fee for service | |
| Oklahoma | No | |||||
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Services limited to funded conditions on the priority list | Yes | Fee for service, using a percentage of Medicare rates |
| Pennsylvania | No | |||||
| Puerto Rico | Yes | CN & MN | Service is included in the capitated rate paid to managed care plans | |||
| Rhode Island | No | |||||
| South Carolina | No | |||||
| South Dakota | Yes | CN | Fee for service for frequently performed services, 40% of charge up to Medicare limits for low volume procedures | |||
| Tennessee | Yes | A, B & C - See state-specific FN | See state-specific FN | |||
| Texas | Yes | CN & MN | Limited to hearing evaluations performed by a qualified audiologist | Yes | Fee for service | |
| Utah | Yes | A, B & C - See state-specific FN | Adult coverage limited to pregnant women | A - Yes | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | 30 visits/year in combination with PT and OT | Fee for service, using Medicare Relative Value Units and a state conversion factor | ||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN & MN | $1/visit | Limited to audiology services | Fee for service | |
| Washington | Yes | CN | 12 visits/year | Yes | Fee for service | |
| West Virginia | Yes | A, B & C | Yes | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3/SP service, depending on payment, up to 30 hours or $1,500/year | Yes | Fee for service | |
| Wyoming | Yes | CN | SP for post-trauma/illness only, rehab potential required and are limited to 20 visits/year | Fee for service |
2010
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 40 No - 16 | Yes - 12 No - 28 | ||||
| Alabama | No | |||||
| Alaska | Yes | CN | Fee for service at 85% of physician fee | |||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | $2.30/service | Outpatient services limited to ALTCS members - see state-specific FN | Yes | Fee for service |
| Arkansas | No | |||||
| California | Yes | CN & MN | $1/visit | Coverage limited to pregnant or institutionalized adults, physician order required | Services after initial 6-month evaluation | Fee for service |
| Colorado | Yes | CN | Audiology procedures limited to specified conditions | Fee for service | ||
| Connecticut | No | |||||
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | No | |||||
| Florida | Yes | CN & MN | Limited to services for provision of augmentative and assistive communication systems | Fee for service | ||
| Georgia | No | |||||
| Guam | Yes | CN | Audiology services limited to evaluation necessary for provision of hearing aid | Fee for service | ||
| Hawaii | Yes | CN & MN | Yes | Fee for service | ||
| Idaho | Yes | CN | 1 audiological testing and evaluation/year, 40 sessions speech therapy/year | Fee for service | ||
| Illinois | Yes | CN & MN | Services other than to continue therapy provided in previous 30 days on inpatient basis | Fee for service or certified cost | ||
| Indiana | Yes | CN | 1 audiological testing and evaluation/3 years, 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge | Specified services including therapy not following hospital discharge | Fee for service | |
| Iowa | Yes | CN & MN | $2/day | Services must be coordinated/provided through a rehab agency or outpatient hospital and can include an audiological assessment for a hearing aid | Fee for service | |
| Kansas | Yes | CN & MN | $3/service | Limited to SP for post-trauma or illness only, physician order and rehab potential required, specified limits regarding audiological testing and evaluation | Fee for service | |
| Kentucky | No | |||||
| Louisiana | No | |||||
| Maine | Yes | CN & MN | $.50-$2/day for SP services, depending on payment, up to $20/month | Decline in oral communication or ability to chew or swallow must be demonstrated, rehab potential required | Fee for service | |
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | For more than 35 visits/year | Fee for service | ||
| Michigan | Yes | CN & MN | Yes | Fee for service | ||
| Minnesota | Yes | A & B - See state-specific FN | After initial 50 sessions | Fee for service | ||
| Mississippi | No | |||||
| Missouri | Yes | CN | Adult coverage limited to those who are pregnant, blind or residing in nursing facilities | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $3/SP visit, $2/visit audiology service | A - 70 SP visits/year, 30 additional possible with prior approval; audiology services limited to evaluation necessary for provision of hearing aid; B - limited to audiological evaluation necessary for provision of a hearing aid essential for employment | Fee for service | |
| Nebraska | Yes | CN & MN | $2 or $3/specified services - see state-specific FN | 60 visits/year in combination with other therapies, rehab potential required | Fee for service | |
| Nevada | Yes | CN | Rehab potential required, audiological testing and evaluation requires physician order | Yes | Fee for service | |
| New Hampshire | Yes | CN & MN | Eighty 15-minute time units/year included in limits with other therapy providers | Fee for service | ||
| New Jersey | No | |||||
| New Mexico | Yes | CN | A - $0-$7/visit depending on income, B - $7/visit - see state-specific FN | Audiological testing and evaluation require physician order; A - limited to short-term treatment up to 60 days per condition but may be extended for additional 60 days with prior approval | Yes | Fee for service |
| New York | Yes | CN & MN | Quantity and frequency limitations vary by procedure | Fee for service | ||
| North Carolina | No | |||||
| North Dakota | Yes | CN & MN | $1/SP visit, $2/audiological evaluation | 1 speech evaluation/year, 30 SP visits/year | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Yes | |||
| Ohio | Yes | CN | 30 dates of service/year in non-institutional setting | Specified services | Fee for service | |
| Oklahoma | No | |||||
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Services limited to funded conditions on the priority list | Yes | Fee for service, using a percentage of Medicare rates |
| Pennsylvania | No | |||||
| Puerto Rico | Yes | CN & MN | Service is included in the capitated rate paid to managed care plans | |||
| Rhode Island | No | |||||
| South Carolina | No | |||||
| South Dakota | Yes | CN | Fee for service for frequently performed services, 40% of charge up to Medicare limits for low volume procedures | |||
| Tennessee | Yes | A & B - See state-specific FN | See state-specific FN | |||
| Texas | Yes | CN & MN | 180 days/episode of care | Yes | Fee for service | |
| Utah | Yes | A, B & C - See state-specific FN | Adult coverage limited to pregnant women | A - Yes | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | 30 visits/year in combination with PT and OT | Fee for service, using Medicare Relative Value Units and a state conversion factor | ||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN & MN | $1/visit | Limited to audiology services | Fee for service | |
| Washington | Yes | CN | 12 visits/year | Yes | Fee for service | |
| West Virginia | Yes | A, B & C | Yes | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3/SP service, depending on payment, up to 30 hours or $1,500/year | Yes | Fee for service | |
| Wyoming | Yes | CN | SP for post-trauma/illness only, rehab potential required and are limited to 20 visits/year | Fee for service |
2008
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 37 No - 19 | Yes - 11 No - 26 | ||||
| Alabama | No | |||||
| Alaska | Yes | CN | Fee for service at 85% of physician fee | |||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Outpatient services limited to ALTCS members - see state-specific FN | Yes | Fee for service | |
| Arkansas | No | |||||
| California | Yes | CN & MN | $1/visit | Physician order required, 2 speech pathology visits/month included in limits with other specified practitioners in any setting | Fee for service | |
| Colorado | Yes | CN | Diagnostic audiology procedures limited to specified conditions | Fee for service | ||
| Connecticut | No | |||||
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | No | |||||
| Florida | Yes | CN & MN | Limited to services for provision of augmentative and assistive communication systems | Fee for service | ||
| Georgia | No | |||||
| Guam | Yes | CN | Audiology services limited to evaluation necessary for provision of hearing aid | Fee for service | ||
| Hawaii | Yes | CN & MN | Yes | Fee for service | ||
| Idaho | Yes | CN | 1 audiological testing and evaluation/year, 40 sessions speech therapy/year | Fee for service | ||
| Illinois | Yes | CN & MN | Physician order required for specified services | Services other than to continue therapy provided in previous 30 days on inpatient basis | Fee for service or certified cost | |
| Indiana | Yes | CN | 1 audiological testing and evaluation/3 years, 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge | Specified services including therapy not following hospital discharge | Fee for service | |
| Iowa | Yes | CN & MN | $2/day | Limited to audiological assessment for a hearing aid | Fee for service | |
| Kansas | Yes | CN & MN | $3/service | Limited to speech pathology for post-trauma or illness only, physician order and rehab potential required, specified limits regarding audiological testing and evaluation | Fee for service | |
| Kentucky | No | |||||
| Louisiana | No | |||||
| Maine | Yes | CN & MN | $.50-$2/day for speech pathology services, depending on payment, up to $20/month | Decline in oral communication or ability to chew or swallow must be demonstrated, rehabilitation potential required | Fee for service | |
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | For more than 35 visits/year | Fee for service | ||
| Michigan | No | |||||
| Minnesota | Yes | A & B - See state-specific FN | After initial 80 sessions | Fee for service | ||
| Mississippi | No | |||||
| Missouri | Yes | CN | Adult coverage limited to those who are pregnant, blind or residing in nursing facilities | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $3/speech pathology visit, $2/visit audiology service | A - 70 speech pathology visits/year, 30 additional possible with prior approval, audiology services limited to evaluation necessary for provision of hearing aid, B - limited to audiological evaluation necessary for provision of a hearing aid essential for employment | Fee for service | |
| Nebraska | Yes | CN & MN | $2 or $3/specified services - see state-specific FN | 60 visits/year in combination with other therapies, rehab potential required | Fee for service | |
| Nevada | Yes | CN | Rehab potential required, audiological testing and evaluation requires physician order | Yes | Fee for service | |
| New Hampshire | Yes | CN & MN | Eighty 15-minute time units/year included in limits with other therapy providers | Fee for service | ||
| New Jersey | No | |||||
| New Mexico | Yes | CN | A - $5/visit, B - $7/visit - see state-specific FN | Audiological testing and evaluation require physician order | Yes | Fee for service |
| New York | Yes | CN & MN | Fee for service | |||
| North Carolina | No | |||||
| North Dakota | Yes | CN & MN | $1/speech pathology visit, $2/audiological evaluation | 1 speech evaluation/year, 30 speech therapy visits/year | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Yes | |||
| Ohio | Yes | CN | 30 dates of service/year in non-institutional setting | Specified services | Fee for service | |
| Oklahoma | No | |||||
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Yes | Fee for service | |
| Pennsylvania | No | |||||
| Puerto Rico | Yes | CN & MN | Fee for service for contracted staff | |||
| Rhode Island | No | |||||
| South Carolina | No | |||||
| South Dakota | Yes | CN | Fee for service for frequently performed services, 40% of charge up to Medicare limits for low volume procedures | |||
| Tennessee | Yes | A & B - See state-specific FN | ||||
| Texas | No | |||||
| Utah | Yes | A, B & C - See state-specific FN | A - Yes | Fee for service | ||
| Vermont | No | |||||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN & MN | $1/visit | Limited to audiology services | Fee for service | |
| Washington | Yes | CN | 12 visits/year | Yes | Fee for service | |
| West Virginia | Yes | A, B & C | A - 20 visits/year in combination with other therapies | Yes | Fee for service | |
| Wisconsin | Yes | CN & MN | $.50-$3/speech pathology service, depending on payment, up to 30 hours or $1,500/year | Yes | Fee for service | |
| Wyoming | Yes | CN | Speech pathology for post-trauma/illness only, rehab potential required | Fee for service |
2006
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 37 No - 19 | Yes - 11 No - 26 | ||||
| Alabama | No | |||||
| Alaska | Yes | CN | Fee for service at 85% of physician fee | |||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Outpatient services limited to ALTCS members - see state-specific FN | Yes | Fee for service | |
| Arkansas | No | |||||
| California | Yes | CN & MN | $1/visit | Physician order required, 2 speech pathology visits/month included in limits with other specified practitioners in any setting | Fee for service | |
| Colorado | Yes | CN | Diagnostic audiology procedures limited to specified conditions | Fee for service | ||
| Connecticut | No | |||||
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | No | |||||
| Florida | Yes | CN & MN | Limited to services for provision of augmentative and assistive communication systems | Fee for service | ||
| Georgia | No | |||||
| Guam | Yes | CN | Audiology services limited to evaluation necessary for provision of hearing aid | Fee for service | ||
| Hawaii | Yes | CN & MN | Rehab potential required | Yes | Fee for service | |
| Idaho | Yes | CN | 1 audiological testing and evaluation/year, speech pathology not covered | Fee for service | ||
| Illinois | Yes | CN & MN | Physician order required for specified services | Services other than to continue therapy provided in previous 30 days on inpatient basis | Fee for service or certified cost | |
| Indiana | Yes | CN | 1 audiological testing and evaluation/3 years, 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge | Specified services including therapy not following hospital discharge | Fee for service | |
| Iowa | Yes | CN & MN | $2/day | Limited to audiological assessment for a hearing aid | Fee for service | |
| Kansas | Yes | CN & MN | $3/service | Limited to speech pathology for post-trauma or illness only, physician order and rehab potential required, specified limits regarding audiological testing and evaluation | Fee for service | |
| Kentucky | No | |||||
| Louisiana | No | |||||
| Maine | Yes | CN & MN | $.50-$2/day for speech pathology services, depending on payment, up to $20/month | Decline in oral communication or ability to chew or swallow must be demonstrated, rehabilitation potential required, 1 initial evaluation and 2 re-evaluations/year, audiological evaluations preliminary to provision of hearing aids not covered | Fee for service | |
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | For more than 35 visits/year | Fee for service | ||
| Michigan | No | |||||
| Minnesota | Yes | A & B - See state-specific FN | After initial 80 sessions | Fee for service | ||
| Mississippi | No | |||||
| Missouri | Yes | CN | Adult coverage limited to those who are pregnant, blind or residing in nursing facilities | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $3/speech pathology visit, $2/visit audiology service | A - 70 speech pathology visits/year, 30 additional possible with prior approval, audiology services limited to evaluation necessary for provision of hearing aid, B - limited to audiological evaluation necessary for provision of a hearing aid essential for employment | Fee for service | |
| Nebraska | Yes | CN & MN | $2 or $3/specified services - see state-specific FN | Rehab potential required | Fee for service | |
| Nevada | Yes | CN | Rehab potential required, audiological testing and evaluation requires physician order | Yes | Fee for service | |
| New Hampshire | Yes | CN & MN | Eighty 15-minute speech pathology time units/year included in limits with other specified practitioners, augmentative communication devices not covered | Fee for service | ||
| New Jersey | No | |||||
| New Mexico | Yes | CN | A - $5/visit, B - $7/visit - see state-specific FN | Audiological testing and evaluation require physician order | Yes | Fee for service |
| New York | Yes | CN & MN | Fee for service | |||
| North Carolina | No | |||||
| North Dakota | Yes | CN & MN | $1/speech pathology visit, $2/audiological evaluation | 1 speech evaluation/year, 30 SP visits/year included in limits for other specified providers | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Yes | |||
| Ohio | Yes | CN | Fee for service | |||
| Oklahoma | No | |||||
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Yes | Fee for service | |
| Pennsylvania | No | |||||
| Puerto Rico | Yes | CN & MN | Fee for service for contracted staff | |||
| Rhode Island | No | |||||
| South Carolina | No | |||||
| South Dakota | Yes | CN | Fee for service for frequently performed services, 40% of charge up to Medicare limits for low volume procedures | |||
| Tennessee | Yes | A & B - See state-specific FN | ||||
| Texas | No | |||||
| Utah | Yes | A, B & C - See state-specific FN | B - speech pathology limited to treatment following trauma or due to congenital defect, C - speech pathology not covered, 1 audiological evaluation for hearing aid/year | A - Yes | Fee for service | |
| Vermont | No | |||||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN & MN | $1/visit | Limited to audiology services | Fee for service | |
| Washington | Yes | CN | 12 visits/year | Yes | Fee for service | |
| West Virginia | Yes | CN & MN | 20 visits/year in combination with other therapies | Yes | Fee for service | |
| Wisconsin | Yes | CN & MN | $1/audiological testing service; $.50-$3/speech pathology service, depending on payment, up to 30 hours or $1,500/year | Yes | Fee for service | |
| Wyoming | Yes | CN | Speech pathology for post-trauma/illness only, rehab potential required | Fee for service |
2004
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 36 No - 20 | Yes - 11 No - 25 | ||||
| Alabama | No | |||||
| Alaska | Yes | CN | Fee for service at 85% of physician fee | |||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Coverage limited to ALTCS members - see state-specific FN | Yes | Fee for service | |
| Arkansas | No | |||||
| California | Yes | CN & MN | $1/visit | Physician order required, 2 speech pathology visits/month included in limits with other specified practitioners in any setting | Fee for service | |
| Colorado | Yes | CN | Diagnostic audiology procedures limited to specified conditions | Fee for service | ||
| Connecticut | No | |||||
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | No | |||||
| Florida | No | |||||
| Georgia | No | |||||
| Guam | Yes | CN | Audiology services limited to evaluation necessary for provision of hearing aid | Fee for service | ||
| Hawaii | Yes | CN & MN | Rehab potential required | Yes | Fee for service | |
| Idaho | Yes | CN | 1 audiological testing and evaluation/year, speech pathology not covered | Fee for service | ||
| Illinois | Yes | CN & MN | Physician order required for specified services | Services other than to continue therapy provided in previous 30 days on inpatient basis | Fee for service or certified cost | |
| Indiana | Yes | CN | 1 audiological testing and evaluation/3 years, 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge | Specified services including therapy not following hospital discharge | Fee for service | |
| Iowa | Yes | CN & MN | $2/day | Limited to audiological assessment for a hearing aid | Fee for service | |
| Kansas | Yes | CN & MN | $3/service | Limited to speech pathology for post-trauma or illness only, physician order and rehab potential required, specified limits regarding audiological testing and evaluation | Fee for service | |
| Kentucky | No | |||||
| Louisiana | No | |||||
| Maine | Yes | CN & MN | $.50-$2/day for speech pathology services, depending on payment, up to $20/month | Audiological evaluations preliminary to provision of hearing aids not covered | Fee for service | |
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | For more than 35 visits/year | Fee for service | ||
| Michigan | No | |||||
| Minnesota | Yes | A & B - See state-specific FN | After initial 80 sessions | Fee for service | ||
| Mississippi | No | |||||
| Missouri | Yes | CN | Speech pathology only covered for loss of larynx | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $3/speech pathology visit, $2/visit audiology service | A - 70 speech pathology visits/year, 30 additional possible with prior approval, audiology services limited to evaluation necessary for provision of hearing aid, B - limited to audiological evaluation necessary for provision of a hearing aid essential for employment | Fee for service | |
| Nebraska | Yes | CN & MN | $1 or $3/specified services - see state-specific FN | Rehab potential required | Fee for service | |
| Nevada | Yes | CN | Rehab potential required, audiological testing and evaluation requires physician order | Yes | Fee for service | |
| New Hampshire | Yes | CN & MN | Eighty 15-minute speech pathology time units/year included in limits with other specified practitioners, augmentative communication devices not covered | Fee for service | ||
| New Jersey | No | |||||
| New Mexico | Yes | CN | B - $7/visit - see state-specific FN | Audiological testing and evaluation require physician order | Yes | Fee for service |
| New York | Yes | CN & MN | Fee for service | |||
| North Carolina | No | |||||
| North Dakota | Yes | CN & MN | $1/speech pathology visit, $2/audiological evaluation | 1 speech evaluation/year, 30 SP visits/year included in limits for other specified providers | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Yes | |||
| Ohio | Yes | CN | Fee for service | |||
| Oklahoma | No | |||||
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Yes | Fee for service | |
| Pennsylvania | No | |||||
| Puerto Rico | Yes | CN & MN | Fee for service | |||
| Rhode Island | No | |||||
| South Carolina | No | |||||
| South Dakota | Yes | CN | Fee for service for frequently performed services, 40% of charge up to Medicare limits for low volume procedures | |||
| Tennessee | Yes | A & B - See state-specific FN | ||||
| Texas | No | |||||
| Utah | Yes | A, B & C - See state-specific FN | B - speech pathology limited to treatment following trauma or due to congenital defect, C - speech pathology not covered, 1 audiological evaluation for hearing aid/year | A - Yes | Fee for service | |
| Vermont | No | |||||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN & MN | $1/visit | Limited to audiology services | Fee for service | |
| Washington | Yes | CN | 12 visits/year | Yes | Fee for service | |
| West Virginia | Yes | CN & MN | 10 speech pathology visits/year | Yes | Fee for service | |
| Wisconsin | Yes | CN & MN | $1/audiological testing service; $.50-$3/speech pathology service, depending on payment, up to 30 hours or $1,500/year | Yes | Fee for service | |
| Wyoming | Yes | CN | Speech pathology for post-trauma/illness only, rehab potential required and 20 visits/year | Fee for service |
2003
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 37 No - 19 | Yes - 12 No - 25 | ||||
| Alabama | Yes | CN | Speech pathology only covered for loss of larynx | Fee for service | ||
| Alaska | Yes | CN | Fee for service at 85% of physician fee | |||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Coverage limited to ALTCS members - see state-specific FN | Yes | Fee for service | |
| Arkansas | No | |||||
| California | Yes | CN & MN | $1/visit | Physician order required, 2 speech pathology visits/month included in limits with other specified practitioners in any setting | Fee for service | |
| Colorado | Yes | CN | Diagnostic audiology procedures limited to specified conditions | Fee for service | ||
| Connecticut | No | |||||
| Delaware | No | |||||
| District of Columbia | No | |||||
| Florida | No | |||||
| Georgia | No | |||||
| Guam | Yes | CN | Audiology services limited to evaluation necessary for provision of hearing aid | Fee for service | ||
| Hawaii | Yes | CN & MN | Rehab potential required | Yes | Fee for service | |
| Idaho | Yes | CN | 1 audiological testing and evaluation/year, speech pathology not covered | Fee for service | ||
| Illinois | Yes | CN & MN | Physician order required for specified services | Services other than to continue therapy provided in previous 30 days on inpatient basis | Fee for service or certified cost | |
| Indiana | Yes | CN | 1 audiological testing and evaluation/3 years, 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge | Specified services including therapy not following hospital discharge | Fee for service | |
| Iowa | Yes | CN & MN | $2/day | Limited to audiological assessment for a hearing aid | Fee for service | |
| Kansas | Yes | CN & MN | $3/service | Limited to speech pathology for post-trauma or illness only, physician order and rehab potential required, specified limits regarding audiological testing and evaluation | Fee for service | |
| Kentucky | No | |||||
| Louisiana | No | |||||
| Maine | Yes | CN & MN | $.50-$2/day for speech pathology services, depending on payment, up to $20/month | Audiological evaluations preliminary to provision of hearing aids not covered | Fee for service | |
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | For more than 35 visits/year | Fee for service | ||
| Michigan | No | |||||
| Minnesota | Yes | A & B - See state-specific FN | After initial 80 sessions | Fee for service | ||
| Mississippi | No | |||||
| Missouri | Yes | CN | $.50-$3/service, depending on payment | Speech pathology only covered for loss of larynx | Fee for service | |
| Montana | Yes | CN & MN | $3/speech pathology visit, $2/visit audiology service | 70 speech pathology visits/year, 30 additional possible with prior approval, audiology services limited to evaluation necessary for provision of hearing aid | Fee for service | |
| Nebraska | Yes | CN & MN | $1 or $3/specified services - see state-specific FN | Rehab potential required | Fee for service | |
| Nevada | Yes | CN | Rehab potential required, audiological testing and evaluation requires physician order | Yes | Fee for service | |
| New Hampshire | Yes | CN & MN | Eighty 15-minute speech pathology time units/year included in limits with other specified practitioners, augmentative communication devices not covered | Fee for service | ||
| New Jersey | No | |||||
| New Mexico | Yes | CN | B - $5/visit - see state-specific FN | Audiological testing and evaluation require physician order | Yes | Fee for service |
| New York | Yes | CN & MN | Fee for service | |||
| North Carolina | No | |||||
| North Dakota | Yes | CN & MN | Fee for service | |||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Yes | |||
| Ohio | Yes | CN | Fee for service | |||
| Oklahoma | No | |||||
| Oregon | Yes | CN & MN | $3/visit | Yes | Fee for service | |
| Pennsylvania | No | |||||
| Puerto Rico | Yes | CN & MN | Fee for service | |||
| Rhode Island | No | |||||
| South Carolina | No | |||||
| South Dakota | Yes | CN | Fee for service for frequently performed services, 40% of charge up to Medicare limits for low volume procedures | |||
| Tennessee | Yes | A & B - See state-specific FN | ||||
| Texas | Yes | CN & MN | Audiology services limited to evaluation necessary for provision of hearing aid | Fee for service | ||
| Utah | Yes | A, B & C - See state specific FN | B & C - balance of hearing exam cost over $30 | A & B - adult coverage limited to pregnant women, C - speech pathology not covered and 1 audiological evaluation for hearing aid/year | A - yes | Fee for service |
| Vermont | No | |||||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN & MN | $1/visit | Limited to audiology services | Fee for service | |
| Washington | Yes | CN | 12 visits/year | Yes | Fee for service | |
| West Virginia | Yes | CN & MN | 10 speech pathology visits/year | Yes | Fee for service | |
| Wisconsin | Yes | CN & MN | $.50-$3/ service, depending on payment up to 30 hours or $1,500/year | Yes | Fee for service | |
| Wyoming | Yes | CN | Speech pathology for post-trauma/illness only, rehab potential required | Fee for service |