A Quick Guide How do you bill insurance for speech therapy


In theory, We have discussed How do you bill insurance for speech therapy? sending a bill to an insurance provider after providing speech therapy and waiting to be reimbursed is a straightforward process. Prior authorizations, visit limits, coding issues, determining deductibles, co-pays, and co-insurance, and then setting up an electronic funds transfer (EFT) to get paid can make the process significantly more complicated than it seems.

Because of the emotional toll that medical problems, illness, injury, or permanent disability can take on you and your loved ones, taking every precaution possible to reduce your risk is essential. That’s why it’s so important to consider purchasing family health insurance. This will allow you to concentrate on healing and receiving the help you need without worrying about money.

Will insurance cover speech therapy?

You might believe that your health insurance covers everything, but obtaining reimbursement for speech therapy can be more complicated and time-consuming than you expect. In addition, additional negotiations and appeals can make the process arduous or drawn out. Read on for more information about the benefits of working with an out-of-network speech therapist.

Most households have yet to consider whether their health insurance policy covers speech therapy and, if so, under what circumstances. Those in need of speech therapy can find it at a price they can afford at Therapy Works Together, where they can receive care from licensed professionals with years of experience. If you read on, you’ll see that our speech therapy services could cost you less than what your insurance would cover.

The first step for families thinking about having health insurance pay for speech therapy is to find out what their policy covers in terms of speech therapy. Contact your company’s human resources department for a copy of the plan or an explanation of your speech therapy benefits if you need clarification on what they cover.

Very rarely do health insurance plans detail the circumstances (sometimes referred to as exclusions) under which they will not cover speech therapy. In light of this, you should contact your health insurance provider if they will pay for your child to participate in speech therapy.

It’s helpful to be aware of the following potential barriers to receiving insurance reimbursement for speech-language pathology services before you need them:

1. Your kid may outgrow this phase

Language delays, lisping, auditory processing disorders, and stuttering are frequently not included. Because insurers believe some children will outgrow the problem over time.

2. The school can provide counseling for your kid

 For this reason, many policies exclude school-aged children from coverage for mental health services. However, not all kids can get school therapy unless their condition is considered “educationally handicapping” (or very severe). Further, your child’s progress may be slowed by lengthy wait times and large class sizes.

3. There is no compelling medical reason to do so

Suppose a child needs therapy but doesn’t have a clear medical need (like a stroke, an injury like traumatic brain injury, or a pre-existing condition like Autism or cerebral palsy). In that case, the insurance company may try to avoid paying for it.

If your family is considering having speech therapy services covered by insurance, we’ve compiled a list of the four most important questions to ask your insurance provider.

How often does my insurance cover speech therapy?

See if there is a list of covered conditions and whether or not treatment is covered only in the event of an accident, injury, or illness.

Do I need a doctor’s note to get speech therapy coverage?

A doctor’s prescription may be necessary for speech therapy to be covered by some health insurance policies. Without a prescription, speech therapy may not be covered by insurance.

What are my out-of-pocket costs going to be like?

Even if speech therapy is covered, a deductible, copayment, or coinsurance may be required. How much are you expected to pay if responsibility falls on you?

How many sessions of speech therapy are covered per year?

Many insurance policies limit patients to 60 therapy visits per calendar year. Inquire further for clarification.

How do we bill insurance companies for speech therapy? Unfortunately, there are many limitations to speech therapy coverage that can make the insurance process difficult for families to navigate. Because of this, our mission at Therapy Works Together is to provide families with a cost-effective option that connects them with licensed speech therapists who are genuinely invested in their patients’ successes in meeting their communication targets.

Principles of Billing

1. Fill out the form for your claim

You can start treating the patient once you’ve established that they’re improving. Collect applicable co-payments, co-insurance, or deductibles on the day of service. Document your expenses for the consultation using a CMS 1500 claim form after the event (more info from ASHA here). If you prefer to submit claims the old-fashioned way, that means filling out the form on paper. The following details are required for this task:

  • Service date(s).
  • Medical diagnosis codes according to ICD-10.
  • The CPT codes and any applicable modifiers.
  • Your NPI’s location and the provider’s location where services were rendered.
  • Billing Service (this will be the same if you provided the services and own the private practice).
  • Information about the patient, such as their date of birth, address, and insurance coverage.

Doing this digitally will save you a lot of time. If you use an electronic medical record system (EMR) such as Fusion, the software will populate the form for you based on the information you’ve already entered about your sessions.

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2. Putting in a claim

When you’re done with the CMS-1500 form, please send it to the clearinghouse mandated by your insurance provider. Some businesses only accept electronic claims submissions, while others accept paper and electronic records. Be aware that the reimbursement process will take longer if you submit a paper claim.

Remember that each insurance provider has deadlines for submitting claims, so it’s important to check ahead of time. A year from the service date is typical, though some businesses are more lenient and only give ninety days.

3. Wait. Keep in touch. Think over, fix up Resubmit

You have submitted the claim and are now waiting for a response. In most cases, your electronic medical record (EMR) or an insurance company’s provider portal account will receive your electronic reimbursement advice (ERA). Timeframes for this range from a few days to several weeks (or, in some cases, with Medicare or Medicaid, a month or two). Changes should be made directly on the CMS form. Submit the revised claim as requested by the insurance company, marking box 22 with the appropriate Resubmission Code (7 to replace the claim and 8 to cancel it).

4. Get paid

The insurance company will pay you via electronic funds transfer (EFT) into your specified account or via paper check once the claim has been approved. Put it in your company’s bank account immediately to avoid potential tax problems.

Check out this Frequently Asked Questions session dedicated solely to SLP reimbursement, provided by the American Speech-Language-Hearing Association. All addressed are where to look for ICD-10 and CPT codes, the difference between a super bill and a CMS-1500 form, and how to document your sessions.

How Do We Charge For Speech Therapy?

NOVA Speech and Language Therapy, LLC, does not process individual insurance claims for speech and language services. You can submit our monthly invoice to your insurance provider for possible reimbursement, including diagnostic and treatment codes. Also, you can use your HSA to pay for our services. ​

Tips for Working with Your Insurance Company.

Before beginning therapy, please consider the following recommendations.

  • You could inquire about “out-of-network benefits” by calling your insurance provider.
  • If you need to complete any paperwork, ensure you know where to find it.
  • Learn the going rate for reimbursements. In most cases, your insurance company will start paying for speech therapy once your deductible has been met. If you’re footing the bill up front, tell your insurer that they should make reimbursement checks out to you directly.
  • You should contact your insurance provider to determine how much they will pay for each CPT code for speech therapy. Invoices typically include the following standard codes: ​
  • ​Individualized speech and language therapy 92507.
  • Group language and communication therapy (Providence Code 92508).
  • Analysis of vocalization quality (HW 92522).
  • Speech and language production and comprehension evaluation (HW 92523).

What’s a CPT code?

Medical, diagnostic, and surgical procedures and services can be described using the current Procedural Terminology (CPT) codes. CPT codes are a standardized method of describing medical functions developed by the American Medical Association. Medical billing is just one application of CPT codes’ wide range of uses.

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How much does insurance cover for speech therapy?

You may have access to valuable benefits outside of your network. Your insurance provider may reimburse you up to 80 percent of the cost of each speech therapy session if you have good out-of-network benefits.


So! In this article, we’ve discussed How do you bill insurance for speech therapy? If you’ve made it this far, I appreciate it. Ultimately, we’d like this blog to demonstrate why medical records are crucial to revenue cycle management. Proper medical documentation, including a detailed explanation of the services’ medical necessity, and error-free claims submissions are requirements for providers. Easy billing begins with precise documentation. In the long run, you will thanks yourself for making it a habit to keep up with recent developments. Need assistance with medical billing? Regarding speech therapy billing and coding, we are here to help.


How often does therapy get covered by insurance?

Many medical insurance policies cover occupational and speech therapy, but these benefits often come with strings attached. The number of therapy sessions a child can receive in a year may be capped depending on factors like age, diagnosis, and insurance coverage. Check with your insurance provider to learn about any exclusions that may apply to your situation.

What is a deductible?

When insurance kicks in, it does so after you’ve paid your deductible. Depending on your policy, the deductible amount may reset every calendar year or every plan year. If you have a deductible and still need to meet it, you will be responsible for paying the total cost of each visit until you do.

What is the co-pay?

Some insurance plans require you to pay a co-insurance amount after you’ve met your deductible. Depending on the policy, the co-pay maybe $0 or $100. Co-payments are due in full at the time of service.

What does coinsurance mean?

After a deductible is met, some plans require a co-insurance payment at the time of service. This is the share of the agreed-upon total that your specific policy mandates you pay. The co-insurance payment is due on the same day as the service, just like the co-pay.

What happens after I send back the forms for a new patient?

A billing specialist will review your insurance coverage after we receive the completed packet and any necessary prescriptions from your doctor. The receptionists will then take your paperwork and set you up with an initial assessment. Verify with your insurance company whether or not they will cover the cost of speech-language pathologist services once you have been given a date for an evaluation.