CommercialCoverageMedium impact
Speech Therapy
Blue Cross & Blue Shield of Mississippi·MS · Pediatrics, Neurology, PM&R (Physical Medicine & Rehab)·Medical Policy
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
This speech therapy policy update clarifies coverage criteria for pediatric and developmental disorders, requiring test scores below the 20th percentile or 15% age delay for medical necessity. The policy also specifies excluded conditions and maintenance therapy limitations.
Action Required
Billing team must verify speech therapy claims include standardized test scores showing results below 20th percentile or 15% age delay for pediatric/developmental cases. Update prior authorization requests to include specific diagnostic criteria. Ensure documentation meets medical necessity requirements before submitting claims to avoid denials.