LSVT BIG and LSVT LOUD are billed under typical therapy billing codes, which are not unique to LSVT. Thus, if your policy has coverage for speech, physical, or occupational therapy and you meet the requirements set by the insurance company, treatments are typically covered. As will all therapies, we strongly advise that you understand your benefits and check with your insurance provider for questions.
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Crucial Questions: Insurance Coverage and Considerations for LSVT LOUD® and LSVT BIG®
There are no standardized rates for LSVT BIG or LSVT LOUD treatment. You should contact local providers to discuss rates as well as consult with your insurance provider in order to fully understand any co-pays that may apply. LSVT BIG and LSVT LOUD rates are no more or less than other speech, physical, or occupational therapy session rates of the same length.
Medicare does provide coverage for speech, physical, and occupational therapy. LSVT LOUD and LSVT BIG are types of these therapies. As with any questions related to insurance coverage, it is imperative that you discuss your individual situation with your insurance/Medicare representative, the healthcare organization from whom you will receive treatment, and your individual LSVT Clinician. There are many variances associated with Medicare coverage (e.g., co-pays) that you will want to fully understand before starting treatment.
The Medicare therapy cap is a yearly dollar amount set by the Centers for Medicare & Medicaid Services (CMS) for speech and physical therapy services combined and a separate amount for occupational therapy services. Reaching the “cap” does not necessarily mean your coverage ends. If medical necessity persists and continued skilled care is documented, modifying codes can be used to allow therapy services to continue. Consult with the healthcare organization’s billing office, your individual Medicare contact and the therapist providing services to fully understand your individual situation.
Possibly. Allowance of telehealth (telepractice, telemedicine) coverage for speech therapy services varies from state to state and country to country. There are many reported cases of successful coverage. We encourage you to explore the options with the facility or clinician from whom you are receiving therapy and your insurance carrier. Currently, Medicare in the United States does not cover speech therapy services delivered via telehealth.
The good news is that there are a number of published articles demonstrating that LSVT LOUD delivered via telehealth is as effective as LSVT LOUD delivered face-to-face in the clinic. These data can be a good tool to advocate for insurance coverage for LSVT LOUD via telehealth.
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