Does Medicare Cover Speech-Language Pathology Services?
Medicare will cover speech-language pathology services to help a patient cope with challenges, such as difficulty speaking and swallowing after a stroke or traumatic brain injury, if a doctor or health care provider certifies that the therapy is medically necessary.
Medicare Coverage of Speech-Language Pathology Services
Medicare covers speech-language pathology services, or speech therapy, if you have a condition that makes the treatment medically necessary. Many of the ailments that speech-language pathology services can help treat happen because of a stroke or other brain injury.
In the past, Medicare put a cap on how much coverage it would provide for this type of service in a calendar year. But that cap has since been lifted, so you can now receive as much speech-language therapy services as medically necessary to help with your condition.
Inpatient vs Outpatient Speech Therapy Services
Medicare Part B will pay 80 percent of the Medicare-approved cost of speech therapy if you receive the services as an outpatient. If you receive this care as an inpatient or in a skilled nursing facility, you will be covered under Medicare Part A.
Coverage options outside of Original Medicare are available as well. A Medicare Advantage plan includes additional benefits and could offer expanded coverage for speech-language pathology or related services.
If you are interested in coverage beyond what is offered under Part A and Part B, check to see what coverage could be available for speech-language pathology services through a Medicare Advantage plan.
Speech-Language Pathology Services By Condition
A condition must be serious for Medicare to cover speech-language pathology services.
- Hearing Loss
- Multiple Sclerosis
Speech-language pathology can mean different things depending on the condition being treated. The therapy typically includes evaluation of your speech, cognitive function, communication and ability to swallow.
Undergoing these treatments with a speech-language pathologist can improve language comprehension, speaking ability and communication skills.
Aphasia is one of the ailments most commonly treated by speech-language pathology. According to the U.S. National Library of Medicine, about a third of people who have a stroke develop this language disorder.
The condition doesn’t affect your intelligence, but it does impact your ability to speak and communicate and can dramatically impact your day-to-day life.
While the severity of the condition can lessen over time, speech-language pathology services can provide further improvement. Treatment can help you make the best use of the language skills you do have, as well as teach you alternative forms of communication like using gestures or pictures.
Treatment for dysphagia, which causes difficulty swallowing, is also typically covered by Medicare because the disorder can lead to serious conditions like choking and aspiration.
Speech-language pathology services utilize a few different methods to treat dysphagia, including the use of thermal stimulation to increase swallowing sensitivity. The treatment can also incorporate oral motor exercises and potential diet adjustments.
Medicare may also cover speech-language pathology services for hearing loss if your doctor or health care provider determines that other options like a hearing aid or cochlear implant will not be effective for you.
Speech therapy services for hearing loss may include lessons on how to read lips and how to better understand forms of nonverbal communication.
9 Cited Research Articles
- University of St. Augustine for Health Sciences. (2020, March). What Is a Speech Language Pathologist & What Do They Do? Retrieved from https://www.usa.edu/blog/what-is-a-speech-pathologist/
- U.S. Centers for Medicare & Medicaid Services. (2019, July). Medicare Coverage of Skilled Nursing Facility Care. Retrieved from https://www.medicare.gov/Pubs/pdf/10153-Medicare-Skilled-Nursing-Facility-Care.pdf
- National Institute on Deafness and Other Communication Disorders. (2017, March 6). Aphasia. Retrieved from https://www.nidcd.nih.gov/health/aphasia
- National Institute on Deafness and Other Communication Disorders. (2017, March 6). Dysphagia. Retrieved from https://www.nidcd.nih.gov/health/dysphagia
- Brady, M. et al. (2016, June 1). Speech and Language Therapy for Aphasia Following Stroke. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078645/
- U.S. Centers for Medicare & Medicaid Services. (2009, April 24). Speech-Language Pathology Private Practice Payment Policy. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R106BP.pdf
- U.S. Centers for Medicare & Medicaid Services. (2006, October 1). National Coverage Determination (NCD) for Speech-Language Pathology Services for the Treatment of Dysphagia (170.3). Retrieved from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=192&ncdver=2&bc=AAAAEAAAAAAA&
- American Stroke Association. (n.d.). Aphasia and Stroke. Retrieved from https://www.stroke.org/en/about-stroke/effects-of-stroke/cognitive-and-communication-effects-of-stroke/stroke-and-aphasia
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Speech-Language Pathology Services. Retrieved from https://www.medicare.gov/coverage/speech-language-pathology-services