10.06.01o, Speech Therapy

By 12/31/2025: Billing team must update documentation requirements and benefit verification workflows to ensure compliance with the revised policy. (1) Update internal guidelines to emphasize that speech therapy services require prescription by a professional provider and must address communication/swallowing disorders stemming from disease, surgery, injury, congenital/developmental anomalies, or prior therapeutic processes. (2) Implement mandatory individual member benefit verification for all speech therapy claims before submission, noting that state mandates do not automatically apply to all plans. (3) Audit current speech therapy claims submitted for CPT codes 92507, 92508, 92521, 92522, 92523, 92524, 92526 and HCPCS codes G0153, G0161, S9128, S9152 to ensure documentation reflects the prescribed provider and qualifying disorder etiology. (4) Train providers and front-desk staff to verify member benefits and state mandate applicability (NJ biologically-based mental illness, PA ASD, PA stuttering) prior to scheduling or billing. (5) Update claim submission templates and prior authorization forms to include fields documenting provider prescribing and disorder origin. Failure to verify individual benefits or comply with the narrowed medical necessity criteria may result in claim denials. This policy applies to Independence Blue Cross Commercial plans in NJ and PA.