The department will pay for speech-language pathology services and supplies

1. (1) that are identified in the Fee Schedule for Therapy Services, adopted by reference in 7 AAC 160.900; and

2. (2) if those services and supplies, except the initial evaluation, are

   1. (A) prescribed by a physician, advanced practice registered nurse (APRN), or physician assistant {PA) enrolled under 7 AAC 105 - 7 AAC 160 and the services and supplies prescribed are within the scope of the practitioner's license;
   2. (B) within the scope of practice of an speech-language pathologist or speech-language pathology assistant;
   3. (C) provided by or under the direction of a speech-language pathologist who is enrolled under 7 AAC 105 - 7 AAC 160;
   4. (D) provided in accordance with the initial evaluation conducted under 7 AAC 115.420(a) and treatment plan developed by the speech-language pathologist under 7 AAC 115.420(b); and
   5. (E) documented in a progress note to include start and stop times for time-based billing codes used as provided in the Healthcare Common Procedure Coding System (HCPCS), adopted by reference in 7 AAC 160.900.

3. (3) for an individual 21 years of age or older, the department will pay for

   1. (A) eight units of speech-language therapy evaluation services each state fiscal year;
   2. (B) 15 units of speech-language therapy services each state fiscal year; and
   3. (C) additional units of occupational therapy services if the department gives prior authorization based on medical justification submitted by the provider.

(Eff. 2/1/2010, Register 193; am 4/24/2020, Register 234; am 3/3/2023, Register 245)

Authority: AS 47.05.010, AS 47.07.030, AS 47.07.040