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Conditions for Coverage
To be considered medically necessary, all of the following conditions must be met:
Coverage for Children
For clients who are 20 years of age and younger, the following conditions must be met:
Coverage for Adults
For clients who are 21 years of age and older, the following conditions must be met:
Developmental Delay Criteria
To establish a developmental delay, all of the following criteria must be met:
Specific developmental delay criteria requirements for speech diagnoses are as follows:
If the client’s test score is less than 1.5 SD below the mean, additional documentation supporting the client’s medical need for therapy will be considered and the request will be sent to physician review to determine medical necessity.
Criteria for Discontinuation of Therapy
Discontinuation of therapy may be considered in one or more of the following situations:
TMHP Physical Therapy, Occupational Therapy and Speech Therapy Handbook