CSHCN 2009 >33.2.1 Authorization Requirements

The initial SLP evaluation does not require authorization. Only one evaluation is considered for payment per 6-month period without authorization or written documentation of medical necessity. An evaluation is not considered for reimbursement if it is performed on the same date of service as treatment.

Note: To assure there is no duplication of therapy services, any child eligible for special education services must have a copy of their IEP or a statement from the independent school district to verify that the child is not eligible for the same services through the school included with an authorization request in order to submit claims for reimbursement of therapy services.

SLP services may be authorized, if the client meets one of the following criteria:

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Meets other program criteria and has a cleft lip or palate or other craniofacial anomaly


Procedure or Condition	Frequency and Duration	Age
SLP Evaluation
Speech pathology evaluation	1 per patient, per 6-month period does not require authorization. More frequent evaluation schedules will require documentation of medical necessity. An evaluation will not be reimbursed on the same day as treatment.	Up to 21 years of age
Reevaluation	May be reimbursed 1 time per month.	Up to 21 years of age
Speech pathology evaluation or re-evaluation of dysphagia (swallowing disorders), or cleft palate or severe craniofacial anomalies, if the SLP is assisting a dentist, radiologist, orthodontist, or surgeon with diagnostic procedures	Authorizations are based upon documentation of the dentist's, radiologist's, orthodontist's, or surgeon's diagnostic procedure schedule. Authorization up to 3 evaluations per year is permissible.	Up to 21 years of age
Equipment assessment for augmentative communication device or system (ACDs) or other communication technology	1 equipment assessment may be authorized before receipt of the equipment through rental arrangement or purchase. Note: Time for adjustment of the ACDs will be included as part of the therapy session.	Up to 21 years of age
SLP Therapy Services
Dysphagia (swallowing disorders), cleft palate, or severe craniofacial anomalies	Up to 2 times a week for 6 months. Extensions are permitted without further medical justification for up to 1 year. After 1 year will require documentation of continued medical necessity on an annual basis.	Up to 21 years of age
Developmental anomalies, including but not limited to: cerebral palsy (CP) or significant hearing loss when there is a voice, articulation, expressive language, or receptive language disorder, or with swallowing dysfunction or oral dysfunction for feeding	Up to 2 times a week for 6 months. May be extended up to 3 years of age. Authorization extension for 6-month intervals up to 3 years of age. physician's prescription good for 6 months.	Up to 3 years of age;
Developmental anomalies, including but not limited to: cerebral palsy (CP) or significant hearing loss when there is a voice, articulation, expressive language, or receptive language disorder, or with swallowing dysfunction or oral dysfunction for feeding	May be authorized with documentation of medical necessity if client is ineligible for special education services or the child has a new condition.	3 to 21 years of age
New conditions, for example: traumatic brain injury, brain tumor, brain embolism, stroke cerebrovascular accident (CVA); other conditions that affect voice, articulation, expressive language, or receptive language	Up to 5 times a week for 3 months. Begin therapy no later than 1 year after date of onset of new condition. May authorize extension for 6-month intervals based upon documentation of continued medical necessity for up to 1 year. After 1 year additional medical justification will be required.	Up to 21 years of age
Training sessions in the use of technology (including ACD and the required adjustments or modifications)	Up to 5 times a week for 1 month after receipt of the device, then 3 times a week for 2 months. Additional requests will require documentation of continued medical necessity.	Up to 21 years of age
Rehabilitation postcochlear implant	Therapy up to 5 times a week for 3 months beginning 4 to 6 weeks post-operatively. May be extended at this frequency based on medical necessity for up to 1 year. Therapy frequency will decrease to 3 times a week for the second and third postoperative year. Requests for therapy at other frequencies will require documentation of medical necessity. If the client is receiving these services through a school-based therapist, the CSHCN Services Program will not duplicate services but can provide additional therapy if the school is unable to provide therapy at the above described frequencies.	Up to 21 years of age

Children who have a condition other than cleft palate or craniofacial anomaly may be eligible to receive services, if they are expected to make progress toward their individual SLP treatment goals and have any of the following: