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Sometimes speech, language and voice dysfunctions result from congenital anomalies, disease, injury, hearing loss, communication or pervasive developmental disorders or a therapeutic process. Speech therapy is a medical process to evaluate, treat, habilitate and rehabilitate those dysfunctions. Under TRICARE, these services may be cost-shared when medically necessary and provided or prescribed and supervised by a physician.
There are some speech services that are not covered by TRICARE. For example, services provided to address speech, language or communication disorders resulting from occupational or educational deficits are not covered. Myofunctional, or tongue thrust therapy, and videofluroscopy evaluation in speech pathology are considered unproven and, therefore, are not covered.
For beneficiaries ages 3 to 21 who are receiving special education services from a public educational agency, such as the local school system, outpatient speech services may be covered by TRICARE only when timeliness and intensity of the services needed cannot be provided by the public educational agency.
For beneficiaries age 3 to 21, who are receiving special education services from a pubic educational agency, Humana Military must first confirm that services cannot be received from the local school system.
The local educational agency will need to complete an Individual Educational Program (IEP) Form. (A Public Facility Use Certification Form is also acceptable.).
The completed IEP Form (or Public Facility Use Certification Form) should be faxed to Humana Military at 1-877-548-1547 to receive authorization.
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