Does S9152 require prior authorization?

No, S9152 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

What is the Medicare reimbursement rate for S9152?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`S9152`, Speech therapy, re-evaluation

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

The treatment goals and subsequent documentation of treatment results should specifically demonstrate that speech therapy services are contributing to such improvement.
Speech therapy must be provided in accordance with an ongoing, written plan of care that is reviewed with and approved by the treating physician and maintained in the medical record.

Key Coverage Criteria

Z96.21 Presence of cochlear implant status
Z96.3 Presence of artificial larynx
CPT/HCPCS services covered if selection criteria are met (examples listed in the policy):
Z96.20 Presence of otological and audiological implant, unspecified
CPT 92630 - Auditory rehabilitation; pre-lingual hearing loss (covered if selection criteria are met).
CPT 92633 - Auditory rehabilitation; post-lingual hearing loss (covered if selection criteria are met).

3 Active Policies

CARELON-physical-therapy-occupational-therapy-and-speech-therapy-2024-04-14, Physical Therapy Occupational Therapy and Speech Therapy

AETNA-CPB-0243, Speech Therapy

CIGNA-CPG111, Patient Assessments: Medical Necessity Decision Assist Guideline for Evaluations and Re-evaluations

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S9152, Speech therapy, re-evaluation