Voice of Reimbursement: Medicare Coverage for Vocal Disorders

Abstract

Speech-language pathologists (SLPs) who treat patients with vocal disorders find they are the exception —rather than the rule—when it comes to Medicare policy. This article addresses statute, regulations, and policies related to acoustical assessments, endoscopy, electronic speech aids, and tracheo-esophageal prostheses (TEPs). Acoustical assessments have limited recognition in the Medicare program and are only reimbursed in certain states, despite advocacy efforts by the American Speech-Language-Hearing Associaiton and members of the State Medicare Administrative Contractor (SMAC) Network. For endoscopy evaluations, confusion is still prevalent related to the level of physician supervision required, primarily due to the changing policies in 2011. Electronic speech aids are a benefit that is often forgotten, though the national policy allows relatively broad coverage. Finally, TEPs are the subject of SLPs, patients, manufacturers, and Congressional attention due to their limited available secondary to poor reimbursement rates and a 2010 enforcement of distribution policy. Clarification regarding the provision of traditional Medicare services (not Medicare Advantage or supplemental plans managed by private companies) and statute is discussed.