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Effective 8/1/26: New Prior Authorization Requirement for Speech Therapy Evaluations

Date: 04/01/26

Effective for service dates on and after August 1, 2026, Superior HealthPlan will require prior authorization for Speech Therapy Evaluations for all Superior Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), and CHIP members.

Beginning July 1, 2026, prior authorization requests will be accepted for Speech Therapy Evaluations for services on and after August 1, 2026.

Any speech therapy evaluation billed for a service date on and after August 1, 2026, that does not have an associated authorization approval from Superior, will be denied upon receipt of the claim.  

Prior authorization requests for Speech Therapy Evaluation services as well as Physical, Occupational and Speech Therapy services for all Superior Medicaid and CHIP members must be submitted to Superior through one of the following prior authorization request submission methods:

Effective for service dates on and after August 1, 2026, the following Speech Therapy Evaluation services and procedure codes will require prior authorization:

Procedure Code

Procedure Code Description

Clinical Criteria Medical Policy

92506

Evaluation of speech, language, voice, communication, and/or auditory processing

TX.CP.MP.549 Physical, Occupational, and Speech Therapy Services

 

For more information please reference Superior’s Effective May 29, 2026: Clinical Policies webpost.

 

92521

Evaluation of speech fluency

92522

Evaluation of speech sound production

92523

Evaluation of speech sound production with evaluation of language comprehension and expression

92524

Behavioral and qualitative analysis of voice and resonance

92610

Evaluation of swallowing function

Clinical Policy Criteria

Superior has updated its Physical, Occupational, and Speech Therapy Services clinical policy to incorporate clinical criteria to confirm the medical necessity for speech therapy evaluation services. The following policy will be posted on Superior’s website as of May 29, 2026, for use in determining medical necessity for Physical, Occupational and Speech therapy services for all Medicaid and CHIP members and including speech therapy evaluation services on and after August 1, 2026.

For complete information and updated clinical policy information relative to medical necessity criteria for speech therapy evaluations please reference Superior’s Effective May 29, 2026: Clinical Policies webpost.

Applicable Products: Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP

Policy

Updated Policy Revisions for Speech Therapy Evaluations

 TX.CP.MP.549 Physical, Occupational, and Speech Therapy Services

 

  1. Initial ST Evaluation Authorization
  • Requests for initial ST evaluation must include:
    • A speech therapy evaluation order signed and dated within the last 60 days of the prior authorization request, by the member’s PCP (physician or allowed practitioner ) or other appropriate specialist involved in the member’s care.
    • Prior Authorization dates of service, which can span up to 90 days.
    • Documentation supporting medical necessity must be provided in one of the following formats:
      • Texas Health Step visit note that is current per periodicity schedule
      • Office exam note within the last 60 days
      • Physicians Order within the last 60 days
    • For members 5 years of age and younger, documentation of a hearing screening performed per the TH-Steps Periodicity Schedule.  The hearing screen may be performed by a Speech-Language Pathologist who has appropriate training.
      • Hearing Screening is defined as a test administered with a pass/fail result for the purpose of rapidly identifying those persons with possible hearing impairment which has the potential of interfering with communication. If the member failed a hearing screening, either due to behavioral issues, inability to participate in the hearing screen or due to suspected hearing deficit, the following documentation would be expected:
        • In the case of behavioral issues or inability to participate in the hearing screen, an objective description of the behavioral issues and/or inability to participate in the hearing screen along with a statement as to why hearing deficit is not suspected; or
        • In the case of suspected hearing deficit, a referral to an audiologist or physician who is experienced with the pediatric population and who offers auditory services would be appropriate.  Documentation of such a referral must be included in the clinical documentation submitted. Note: If an auditory assessment has not occurred prior to the start of speech therapy, the speech therapy treatment plan must address the suspected hearing loss.
      • For evaluations addressing feeding only, a hearing screening is not required. Note: ST re-evaluations do not require prior authorization for in-network providers.

For questions or additional information, contact Superior’s Prior Authorization department at 1-800-218-7508.