[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR410.62]



[Page 347]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 410_SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS--Table of Contents

 

               Subpart B_Medical and Other Health Services

 

Sec. 410.62  Outpatient speech-language pathology services: Conditions 

and exclusions.



    (a) Basic rule. Except as specified in paragraph (a)(3)(ii) of this 

section, Medicare Part B pays for outpatient speech-language pathology 

services only if they are furnished by an individual who meets the 

qualifications for a speech-language pathologist in Sec. 484.4 of this 

chapter and only under the following conditions:

    (1) They are furnished to a beneficiary while he or she is under the 

care of a physician who is a doctor of medicine or osteopathy.

    (2) They are furnished under a written plan of treatment that--

    (i) Is established by a physician or, effective January 1, 1982, by 

either a physician or the speech-language pathologist who provides the 

services to the particular individual;

    (ii) Is periodically reviewed by a physician; and

    (iii) Meets the requirements of Sec. 410.61.

    (3) They are furnished--

    (i) By a provider as defined in Sec. 489.2 of this chapter, or by 

others under arrangements with, and under the supervision of, a 

provider; or

    (ii) By, or incident to the service of, a physician, physician 

assistant, clinical nurse specialist, or nurse practitioner when those 

professionals may perform speech-language pathology services under State 

law. When a speech-language pathology service is provided incident to 

the services of a physician, physician assistant, clinical nurse 

specialist, or nurse practitioner, by anyone other than a physician, 

physician assistant, clinical nurse specialist, or nurse practitioner, 

the service and the person who furnishes the service must meet the 

standards and conditions that apply to speech-language pathology and 

speech-language pathologists, except that a license to practice speech-

language pathology services in the State is not required.

    (b) Condition for coverage of outpatient speech-language pathology 

services to certain inpatients of a hospital, CAH, or SNF. Medicare Part 

B pays for outpatient speech-language pathology services furnished to an 

inpatient of a hospital, CAH, or SNF who requires the services but has 

exhausted or is otherwise ineligible for benefit days under Medicare 

Part A.

    (c) Excluded services. No service is included as an outpatient 

speech-language pathology service if it is not included as an inpatient 

hospital service if furnished to a hospital or CAH inpatient.

    (d) Limitation. After 1998, outpatient speech-language pathology 

services are subject to the limitation in Sec. 410.60(e).



[51 FR 41339, Nov. 14, 1986, as amended at 53 FR 6648, Mar. 2, 1988; 56 

FR 8852, Mar. 1, 1991; 56 FR 23022, May 20. 1991; 58 FR 30668, May 26, 

1993; 63 FR 58907, Nov. 2, 1998; 69 FR 66422, Nov. 15, 2004]



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