Model Health Care Benefits for Audiology and Speech-Language Pathology Services
ASHA has created model benefit plans to show what ideal coverage for audiology and speech-language pathology services should include. This information is meant to help insurance companies and plan managers design their plans. It may not describe the exact benefits in your current insurance plan. For details about -what your plan covers, please check your plan documents or contact your plan directly.
The model plans outline:
- Which services and devices should be covered.
- When coverage should apply.
- Recommended coverage levels.
- Suggested allowances for devices like hearing aids and AAC (augmentative and alternative communication) tools.
These guidelines can help shape health plans that meet real communication needs and improve access to care.
Have questions? Contact reimbursement@asha.org for more information.
All Current Procedural Terminology (CPT®) codes and descriptors are copyright American Medical Association.
Model Hearing Benefits Plan
| Services and Devices | Coverage Level & Device Allowances | CPT and HCPCS Codes |
| Assessment: Audiological, Tinnitus, Vestibular and Balance, Central Auditory, Cochlear Implant, Hearing Assistive Technology Systems (HATS), Auditory Rehabilitation, Hearing Aid Assessment and Fitting | Covered in full for the pediatric and adult populations for all medical diagnoses that have an ICD-10-CM code. jkfldjkaslfjdalk jfkdlsjfkldasjfkldasjfkldsa | Assessment codes include, but are not limited to: 92537, 92538, 92540 through 92550, 92552 through 92568, 92570 through 92596, 92601 through 92604, 92620, 92621, 92625, 92626, 92627, 92640, 92700, 95920, 95925, 95930, 95934, 95936, 95937, V5008, V5010, V5011, V5014, V5020 |
| Treatment: Audiologic (Aural) Rehabilitation/Habilitation, Vestibular and Balance, Auditory Processing, Cerumen Management, Canalith Repositioning | Covered in full for the pediatric and adult populations for all medical diagnoses that have an ICD-10-CM code as long as measurable and positive functional change is noted in a reasonable time period. [1] | Treatment codes include, but are not limited to: 92507, 92630, 92633, 95992, 97112, 69209, 69210 |
| Devices: Hearing Aid Devices, HATS, Cochlear Implants and Accessories | $3,000 hearing aid or HATS allowance per ear every 3 years | Device codes include, but are not limited to: V5030 through V5265, V5267 through V5269, V5273, V5275, L8619, L7510 |
[1] If a limit on the number of sessions is established, the audiologist should be given the flexibility to determine the frequency and length of the sessions as well as the duration of treatment.
Model Speech and Language Benefit Plan
| Services and Devices | Coverage Level & Device Allowances | CPT and HCPCS Codes |
| Assessment: Speech, Language, Voice, Stuttering, Communication, Cognitive, Auditory Processing, Auditory (Aural) Rehabilitation, Swallowing Function, Augmentative and Alternative Communication (AAC), Voice Prosthetic | Covered in full for the pediatric and adult populations for all medical diagnoses that have an ICD-10-CM code. | Assessment codes include, but are not limited to: 92511, 92520 through 92524, 92597, 92605, 92607, 92608, 92610, 92611, 92612, 92614, 92616, 92626, 92627, 96105, 96110, 96112, 96113, 96125 |
| Treatment: Speech, Language, Voice, Stuttering, Communication, Auditory Processing, Auditory (Aural) Rehabilitation/Habilitation, Cognitive Rehabilitation, Swallowing Function, AAC, Voice Prosthetic | Covered in full for the pediatric and adult populations for all medical diagnoses that have an ICD-10-CM code as long as measurable and positive functional change is noted in a reasonable time period. [1] | Treatment codes include, but are not limited to: 92507, 92508, 92526, 92606, 92609, 92618, 92630, 92633, 97129, 97130, 97150 [2] |
| Devices: AAC and Prosthetic Devices & Accessories | Covered in full if recommended by an ASHA-certified, and/or licensed speech-language pathologist. | Device codes include, but are not limited to: E1902, E2500 through E2512, E2599, L8500 through L8515, V5336 |
[1] If a limit on the number of sessions is established, the speech-language pathologist should be given the flexibility to determine the frequency and length of the sessions as well as the duration of treatment.
[2] The Centers for Medicare & Medicaid Services advises that use of physical medicine and rehabilitation codes (9700 series) are not appropriate for speech-language pathology or dysphagia services, except for 97129/97130. Some Medicare contractors, Medicaid programs, and private payers may allow exceptions. Speech-language pathologists should discuss the appropriate use of the 97000 series of codes with the payer.
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ASHA ProFind is your connection to over 30,000 ASHA-certified audiologists and speech-language pathologists. Find the right professional for your needs.
Search Now