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36.4.8.1 Speech Therapy Post Cochlear Implant
Payment for speech therapy (1-92507) is included as part of the cochlear implant procedure (2-69930). Speech therapy is a benefit of the Texas Medicaid Program under a six month global fee period, for a maximum of 12 visits. Additional speech therapy related to the cochlear implants may be prior-authorized for clients ages 1 through 20 under the THSteps-Comprehensive Care Program (CCP). Reimbursement for speech therapy will be made separately from the surgical fee for cochlear implant.
For clients 12 months of age to 21 years of age, speech therapy is reimbursed through the THSteps-CCP program. For clients 21 years of age and older, speech therapy is reimbursed through the Traditional Texas Medicaid Program when submitted by the hospital or the physician. The Traditional Medicaid Program reimburses a maximum of 12 visits within a 6 month period.
The speech therapy should be prescribed by a physician, provided as an outpatient hospital service, and billed by the hospital; or the therapy should be prescribed by a physician, performed by or under his personal supervision, and submitted by the physician. The service is included in the DRG when provided in an inpatient facility and rehabilitation setting.
Speech evaluations and speech therapy submitted directly by an independently-practicing speech pathologist or audiologist are denied and considered on appeal.
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