Florida Medicaid (speech-language pathology) pediatric speech and OT coverage: limits, prior authorization and who can bill
The short answerSLP only. Florida Medicaid covers SLP evaluations, re-evaluations and treatment for recipients under 21, plus AAC services at any age. Fee-for-service providers need QIO authorization at least every 180 days. Certified speech-language therapy assistants may work under supervision. No treatment visit on the same day as an evaluation.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · Florida. Public policy, not the member's benefits.
Florida Medicaid (speech-language pathology)
Speech-Language Pathology Services Coverage Policy (Rule 59G-4.324) · Florida
| Where it applies | Covers speech-language pathology evaluations, re-evaluations and therapy treatment for recipients under 21, and AAC evaluations and fitting. Group therapy must be at least 30 minutes with no more than six participants. Services above the policy for under 21 may be approved if medically necessary under EPSDT. [1] |
|---|---|
| Visit limits | Treatment visits on the same day as an evaluation are not covered. Untimed codes are paid once per session, regardless of time spent, and multiple units are not billable unless the policy allows it. [1] |
| Prior authorization | For fee-for-service, providers must obtain authorization from the quality improvement organization at least every 180 days, or when the recipient's condition changes enough to alter services. [1] |
| Who can bill | Services must be rendered by licensed or provisionally licensed SLPs, or by certified speech-language therapy assistants working under supervision. SLPs must supervise students and direct care. [1] |
| Managed care plans | Medicaid managed care plans must meet the policy's coverage requirements and cannot apply more stringent service coverage limits than the policy. [1] |
| Also | Not covered: developing and updating the plan of care, time spent supervising assistants and students, and telephone communications except under Rule 59G-1.057. There is no copayment or coinsurance. [1] |
What Florida Medicaid (speech-language pathology)'s documents say
The table above has every field we found for Florida Medicaid (speech-language pathology), with numbered sources. In short:
- Prior authorization. For fee-for-service, providers must obtain authorization from the quality improvement organization at least every 180 days, or when the recipient's condition changes enough to alter services.
- Visit limits. Treatment visits on the same day as an evaluation are not covered. Untimed codes are paid once per session, regardless of time spent, and multiple units are not billable unless the policy allows it.
- Who can bill. Services must be rendered by licensed or provisionally licensed SLPs, or by certified speech-language therapy assistants working under supervision. SLPs must supervise students and direct care.
Other pediatric speech and OT rows for Florida
Florida autism coverage mandate (speech, OT, PT).
Check Florida Medicaid (speech-language pathology)'s claim against the row
Before the claim goes out, compare it with the row above: the evaluation and treatment codes are ones the policy lists, the plan of care and any prior authorization cover the date, and the visit count fits the limit. The pediatric speech and OT table compares Medicaid with every other payer we checked.