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33.2 Benefits, Limitations, and Authorization Requirements
SLP services for a client must be medically necessary, prescribed by a physician, and provided by a speech-language pathologist (SLP) that is licensed by the state of Texas.
The CSHCN Services Program SLP services benefit may be limited to certain conditions, by type of service, by age, by the client's medical status, and whether the client is eligible for services that a school district is legally responsible to provide. SLP services are benefits when provided to clients experiencing speech-language difficulty because of a disease or trauma, developmental delay, oral motor problem, or congenital anomaly.
Clients can receive SLP services from both the CSHCN Services Program and from other sources, such as from school districts, only when the therapy provided by the CSHCN Services Program addresses different client needs. Therapy provided by the CSHCN Services Program is not intended to duplicate, supplement, or replace services that are the legal responsibility of other entities or institutions. The CSHCN Services Program encourages the private therapist to coordinate with other therapy providers to avoid treatment plans that might compromise the clients progress.
Therapy sessions include the time the therapist is with the client, time spent preparing the client for the session, and the time spent completing documentation. Evaluation, reevaluation, and therapy services may not be billed on the same date of service. Reimbursement of an evaluation is limited to once every 6 months. Procedure code S9152 must be used when requesting reimbursement for re-evaluation and is limited to once per month. Providers must bill the appropriate national procedure code for the SLP service provided: 92506, 92507, 92526, 92610, 92630, 92633, 97535, or S9152. Speech-language therapy treatment codes (procedure codes 92507, 92526, and 97535) may be reimbursed in 15-minute increments as prescribed and are authorized up to a maximum of one hour (four treatment units) per day. Procedure codes 92506 and S9152 are limited to one service per day.
Note: Services related to audiological testing, hearing exams, and amplification devices for clients younger than 21 years of age are coordinated through the Program for Amplification for Children of Texas (PACT).
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