Current through Vol. 42, No. 1, September 16, 2024
(a)
Coverage. Payment is made
for speech and hearing services as set forth in this Section.
(1)
Children. Coverage for
children is as follows:
(A)
Preauthorization required. All therapy services, including the
initial evaluation, must be prior authorized. Prior to the initial evaluation,
the therapist must have on file a signed and dated prescription or referral for
the therapy services from the member's physician or other licensed practitioner
of the healing arts. The prescribing or referring provider must be able to
provide, if requested, clinical documentation from the member's medical record
that supports the medical necessity for the evaluation and referral.
(B)
Speech-language pathology
services.
(i) Speech-language
pathology services may include speech-language evaluations, individual and
group therapy services provided by a fully licensed and certified
speech-language pathologist, a licensed speech-language pathology clinical
fellow, and services within the scope of practice of a speech-language
pathology assistant as directed by the supervising speech-language pathologist,
as listed in Oklahoma Administrative Code (OAC)
317:30-5-675(a)
through (c).
(ii) Initial evaluations must be prior
authorized and provided by a fully licensed speech-language
pathologist.
(C)
Hearing aids. Hearing and hearing aid evaluations include pure
tone air, bone and speech audiometry by a state licensed audiologist. Payment
is made for a hearing aid following a recommendation by a medical or
osteopathic physician and a hearing aid evaluation by a state licensed
audiologist.
(2)
Adults. There is no coverage for adults for services rendered by
individually contracted providers. Coverage for adults is permitted in an
outpatient hospital setting as described in OAC
317:30-5-42.1.
(3)
Individuals eligible for Part B of
Medicare. Services provided to Medicare eligible recipients are filed
directly with the fiscal agent.
(b)
Payment rates. All
speech-language pathology and hearing services are reimbursed per the
methodology described in the Oklahoma Medicaid State Plan.
(c)
Procedure codes. The
appropriate procedure codes used for billing speech and hearing services are
found in the Physicians' Current Procedural Terminology (CPT) Coding
Manual.
Added at 12 Ok Reg 751, eff 1-5-95 through 7-14-95
(emergency); Added at 12 Ok Reg 3131, eff 7-27-95 ; Amended at 14 Ok Reg 524,
eff 12-24-96 (emergency); Amended at 14 Ok Reg 1785, eff 5-27-97 ; Amended at
16 Ok Reg 1927, eff 6-11-99 ; Amended at 17 Ok Reg 3516, eff 9-1-00 (emergency)
; Amended at 18 Ok Reg 1130, eff 5-11-01 ; Amended at 24 Ok Reg 82, eff 8-2-06
(emergency); Amended at 24 Ok Reg 932, eff 5-11-07 ; Amended at 29 Ok Reg 477,
eff 5-11-12 ; Amended at 30 Ok Reg 336, eff 1-14-13 (emergency); Amended at 30
Ok Reg 1163, eff 7-1-13
