Insurance Billing and Patient Responsibility:

• In-person regular 45 to 60-minute therapy visits within the Takes2Therapy service area with a full evaluation to determine the plan of care, formal report, and follow-up therapy visits based on the plan of care

• Coverage may be dependent on medical necessity, age, and/or specific medical diagnosis (ICD-10 code)

• Physician documentation and referral may be required to establish medical necessity

• Reimbursement/patient responsibility varies based on individual insurance coverage 

  • Takes2Therapy will directly bill in-network insurance who will determine coverage and patient responsibility

  • Takes2Therapy will inform you of any patient responsibility (applied to your deductible, copay, coinsurance)

  • If there is a covered secondary insurance, Takes2Therapy will file primary and secondary insurance claims

  • If claims are denied, the patient/family is responsible for the "self-pay" rate

 

In-Network Private/Medicaid Insurance:

• Blue Cross Blue Shield

• Blue Cross Blue Shield Medicaid Star/Chip & StarKids*

• Traditional Medicaid*

• United

  *other Medicaid programs, not a provider (i.e. Superior)

​

Out-of-Network Private Insurance:

• Cigna & Aetna- self-pay rates apply with invoice provided to apply to your out-of-network benefits

​

Parents are encouraged to call insurance to inquire regarding their individual plan's speech therapy coverage, including:

• General benefits and eligibility for speech therapy provided in the home (not home health care benefit)

• Any limitations or exceptions

• Copays/coinsurance/out of pocket

• Deductibles

• Pre-authorization or care notification requirements for speech therapy CPT codes (listed below) provided in the home

 

Specific procedure/CPT codes for “Speech Therapy” will include:

• 92610 (Feeding/Swallowing Evaluation)

• 92523 (Speech/Language Evaluation)

• 92526 (Feeding/Swallowing Therapy)

• 92507 (Speech/Language Therapy)

​

"Self-Pay" (No Insurance Billing) Therapy Rates:

• In-person regular therapy visits within the Takes2Therapy service area with a full evaluation to determine the plan of care, formal report, and follow-up therapy visits based on the plan of care

• Evaluation:  $300-325 (45 to 60-minute visit)

• Treatment:  $125-150 (45 to 60-minute visit)

  • An itemized invoice of services and payment will be provided

  • Families may submit paid invoice to insurance reimbursement and confirm if HSA may be used to cover "self-pay" costs

 

Consultative (No Insurance Billing) Telehealth Therapeutic Services:

• Consultative Telehealth services where the family is outside of the Takes2Therapy service area, in-person appointments are not available, and/or the family has established care with outside therapy services and is seeking consultative services

• Consultative Comprehensive Evaluation: $300-325 (45 to 60-minute visit)

  • Prior to the visit, review of medical records, including family feeding history report, physician reports, other feeding therapist assessments, videos of feeding, feeding diary, and/or swallow studies to date

  • Consult visit to observe feeding with recommendations and education provided

  • Post-visit, a comprehensive email with recommendations for any adjustments to the plan of care, projected long term goals, short term goals for a follow-up visit, and educational/resource handouts/links provided

• Consultative Session/Follow-Up/Reassessment:  $125-200 (45 to 60-minute visit)

  • Frequency of consultative visits varies based on needs and complexity of feeding issues and is modified from weekly to monthly based on current needs/progress and projected time to achieve determined short term goals

    • i.e. initially may have an immediate follow-up visit to review plan/answer questions, then the family may work with home feeding therapist on short term goals established with next follow-up visit in one month to check on progress

    • i.e. readiness for tube wean challenge determined and an increase in frequency to weekly visits is needed to safely implement the plan

    • i.e developmental oral-sensory feeding issues only, primarily seeking parent training and consult

  • Collaboration with physicians, other servicing therapies, and/or registered dietician as indicated

  • Prior to the visit, review of progress notes/videos/feeding diary/assessments

  • Post-visit, email with recommendations for any adjustments to the plan of care, short term goals for the next follow-up visit, and any additional educational/resource handouts/links provided

  • If tube weaning, once readiness for a "tube wean challenge" is established, write up of an individualized schedule will be completed and further modified at subsequent follow-up visits based on progress

• Consultative Package: $1,300 paid in full at initial consult ($1,525 value))

  • includes 60-minute initial consult visit & six hours of consult to be used in 45 or 60-minute increments (6 to 8 visits)

  • $150 per any additional hours needed

• Telehealth visits are provided via secure online video/audio connection 

• As these are consultative, Telehealth services, they do not meet requirements for speech therapy CPT codes and may not apply to your speech therapy benefit. 

  • Families will be provided an itemized invoice of "consultative speech therapy" services that they may submit to their insurance for possible reimbursement and/or to apply to their "out of pocket" costs.
     

"No Show" Fee:

• $60 "no show" fee if the appointment is not canceled before the therapist's arrival

​

Family Payment Options:

• Check paid to Takes2Therapy with an itemized paid invoice emailed upon request after payment

• Square itemized invoice with a paid invoice sent electronically after payment

• Venmo @Carmen-Huston-1 with an itemized paid invoice emailed upon request after payment