Stuttering Therapy Outcomes Revisited

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Re: Insurance question

From: Nan
Date: 21 Oct 2009
Time: 14:01:46 -0500
Remote Name: 129.2.25.203

Comments

OK, here we go. I consulted my colleague Steve White, at ASHA, who consulted with HIS colleague Mark Kander, to provide this response. "Here's a combined (my original plus that from Mark) message regarding Medicare that you can post. In the 1980s Medicare SLP coverage guidelines specifically excluded stuttering from coverage. Today, the Centers for Medicare and Medicaid Services (CMS) national Medicare guidelines are found in the online Medicare Benefit Policy Manual. There is no mention of what is excluded from coverage but, rather, examples are given for what are common medical disorders requiring active therapy. The following is a quote from the Benefit Policy Manual: "The following are examples of common medical disorders and resulting communication deficits, which may necessitate active rehabilitative therapy. This list is not all-inclusive: Cerebrovascular disease such as cerebral vascular accidents presenting with dysphagia, aphasia/dysphasia, apraxia, and dysarthria; Neurological disease such as Parkinsonism or Multiple Sclerosis with dysarthria, dysphagia, inadequate respiratory volume/control, or voice disorder; or Laryngeal carcinoma requiring laryngectomy resulting in aphonia." CMS now leaves specific coverage decisions such as that for stuttering in the hands of the Medicare Administrative Contractors (MACs). One would think that it would be easy to find a Medicare local coverage determination (LCD) that says stuttering is specifically excluded, but that is not the case. The first LCD reviewed was for home health (Palmetto GBA - a Medicare contractor) and it states that 307.0 stuttering was a code that supported medical necessity. (Note from Nan: the code for stuttering is likely to move from this section in the near future, which further complicates things. The 307 series tends to reflect "mental disorders" and ASHA currently supports a proposal to move stuttering to the 315 series. which currently contains other childhood onset communication disorders.) Steve continues: "Further research finds two MACS (Palmetto - administers Medicare in 8 states - and Highmark - administers Medicare in 7 states) that mention "fluency" as covered in the narrative and include 307.0 in the list of ICD-9-CM codes that "support medical necessity. Wisconsin Physicians Service (4 states) has developed an SLP LCD for Part A (e.g., hospital inpatient services) only. It does not mention fluency in the narrative but does include 307.0 as covered ICD-9-CM diagnosis. National Government Services (15 states, intermediaries/carriers) is currently transitioning to a 2-state MAC. The SLP LCD states that fluency disorders are "typically non-covered for the geriatric Medicare beneficiary." However, 307.0 is included in the list of covered diagnoses." Final note from Nan: there is an additional, new code for stuttering due to late effect of cerebrovascular accident (438.14) that SHOULD qualify under Medicare, but this code is supposed to be used for adult-onset stuttering following stroke or similar condition. ASHA is currently in discussion with other groups (Pediatrics, Neurology) to add more codes, such as codes for stuttering following head injury or consequent to degenerative disorder - we may have more information in November 2009 on this initiative's likelihood of possible implementation by next year. Everybody confused by all this? As Steve and Mark remind us, "Readers can contact reimbursement@asha.org with any questions." best regards, Nan


Last changed: 10/21/09