Pediatric Coding Alert

Question: I remember hearing that Tricare covers speech therapy but we keep getting denials for it, and I can’t find any guidelines. Can you advise?

Answer: Tricare does include coverage for speech therapy to treat speech, language and voice dysfunctions that occur due to diseases, injuries, birth defects, hearing loss and pervasive developmental disorders, the payer says on its website. However, if you’ve been struggling to collect for these services from Tricare, you could be treating a patient that doesn’t meet the criteria.

Speech therapy is not covered for disorders resulting from educational deficits, myofunctional tongue thrust therapy, videofluoroscopy evaluations, maintenance therapy that doesn’t require a skilled level or special education services. If your patient falls into this category, chances are that the services will be only available to Tricare patients on a cash-pay basis, and you should request that the parent sign an advance beneficiary notice (ABN) in these instances.

Resource: For more on this topic, visit the Tricare website at www.tricare.mil/CoveredServices/IsItCovered/SpeechTherapy.aspx?sc_database=web.