Check code adoption, coverage, authorization, units, edits, documentation, rates and implementation separately. These dated working records retain their October 8–9, 2026 evidence checks; open items require plan-specific verification.
Authorization and code crosswalks
Open authorization routes and the 92507 code crosswalk. Includes existing-approval continuity, visit versus unit conversion, base/add-on approval and payment mapping. Payer conversion rules are labeled separately from the verified coding reference.
HFS Medicaid FFS
| Record |
Payer and scope |
Status |
| r-9928144327 |
Illinois HFS · Medicaid FFS · IL |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Published change: Sept 23 stuttering coverage; therapy fee schedule is the rate entry. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Published change: Sept 23 stuttering coverage; therapy fee schedule is the rate entry. |
| Next verification |
Check J-200 revision and new-code fee schedule, GN/modifiers, pediatric units and authorization. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
Sept 23 stuttering coverage · therapy fee schedule |
| Source locator |
## Illinois Medicaid and school programs → HFS Medicaid FFS |
HFS School-Based Health Services
| Record |
Payer and scope |
Status |
| r-ee50d60060 |
Illinois HFS · School Medicaid · IL |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current schedule: school-based fee schedule effective Apr 1, 2026, updated Jul 21. This is a program, not an insurer. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current schedule: school-based fee schedule effective Apr 1, 2026, updated Jul 21. This is a program, not an insurer. |
| Next verification |
Obtain school-specific code/unit instructions; do not apply outpatient clinic rules to IEP sessions. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
school-based fee schedule effective Apr 1, 2026, updated Jul 21 |
| Source locator |
## Illinois Medicaid and school programs → HFS School-Based Health Services |
BCCHP
| Record |
Payer and scope |
Status |
| r-006eb6f8f4 |
BCBSIL · Medicaid MCO · IL |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Published change: Medicaid ID transition; HFS stuttering notice also covers HealthChoice MCOs. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
2026-11-16 Portal / EDI implementation; 2027-01-01 Member ID implementation |
| Verified reference |
Published change: Medicaid ID transition; HFS stuttering notice also covers HealthChoice MCOs. |
| Next verification |
Test RIN fields and confirm Carelon therapy authorization units and 2027 conversion. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Change |
BCCHP Medicaid RIN becomes the sole member ID in all transactions January 1; Availity/EDI field changes November 16. |
| Date correction |
The URL contains 9-24; the displayed publication date is September 25, 2026. |
| Option for Steph |
Check RIN storage and eligibility/claim-status fields before November 16. |
| Source |
Medicaid ID transition |
| Source locator |
BCBSIL → Providers → News and Updates → Use Medicaid ID Instead of Subscriber ID → Affected transactions / Details to help you prepare |
Aetna Better Health of Illinois
| Record |
Payer and scope |
Status |
| r-cba436cf1b |
Aetna · Illinois Medicaid MCO / Aetna Better Health · IL |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current policy entry: IL clinical and payment policies; HFS stuttering notice applies. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current policy entry: IL clinical and payment policies; HFS stuttering notice applies. |
| Next verification |
Ask for product-specific therapy PA, units and new-code handling; do not borrow Aetna commercial CPB as Medicaid rule. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
IL clinical and payment policies |
| Source locator |
## Illinois Medicaid and school programs → Aetna Better Health of Illinois |
Meridian Health Plan
| Record |
Payer and scope |
Status |
| r-1f035a92ab |
Meridian · Medicaid MCO · IL |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current policy: physical, occupational and speech therapy CP.MP.49; state-fee/program tracker lists the HFS stuttering notice. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current policy: physical, occupational and speech therapy CP.MP.49; state-fee/program tracker lists the HFS stuttering notice. |
| Next verification |
Check implementation date, Evolent/plan PA code list, and 2027 rate/authorization mapping. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
physical, occupational and speech therapy CP.MP.49 · state-fee/program tracker |
| Source locator |
## Illinois Medicaid and school programs → Meridian Health Plan |
YouthCare
| Record |
Payer and scope |
Status |
| r-69b2f33382 |
YouthCare · Medicaid MCO · IL |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current policy/PA entries: clinical policies and service authorization, which routes therapy to Evolent. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current policy/PA entries: clinical policies and service authorization, which routes therapy to Evolent. |
| Next verification |
Verify foster-youth product rules and existing PA conversion separately from Meridian. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
clinical policies · service authorization |
| Source locator |
## Illinois Medicaid and school programs → YouthCare |
Molina Healthcare of Illinois · Medicaid
| Record |
Payer and scope |
Status |
| r-4877dbcf44 |
Molina Illinois · Commercial / plan specific · IL |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current reference: 2026 Medicaid provider manual and IL clinical policies. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current reference: 2026 Medicaid provider manual and IL clinical policies. |
| Next verification |
Pull the current PA lookup and therapy manual section; check exact new codes and HFS coverage implementation. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
2026 Medicaid provider manual · IL clinical policies |
| Source locator |
## Illinois Medicaid and school programs → Molina Healthcare of Illinois · Medicaid |
CountyCare
| Record |
Payer and scope |
Status |
| r-33ec7de37e |
CountyCare · Medicaid MCO · IL |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current PA entry: clinical criteria and authorization portal guidance. Cook County product. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current PA entry: clinical criteria and authorization portal guidance. Cook County product. |
| Next verification |
Confirm therapy delegate, approved units and 2027 crosswalk only if serving a CountyCare member. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
clinical criteria · authorization portal guidance |
| Source locator |
## Illinois Medicaid and school programs → CountyCare |
BCBSIL commercial
| Record |
Payer and scope |
Status |
| r-4a138b9a23 |
BCBSIL · Commercial / plan specific · IL |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Published change: Jan 1 code/fee update. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Published change: Jan 1 code/fee update. |
| Next verification |
Request code-specific PPO/Blue Choice allowances and PA/medical-policy mapping; compare both network contracts. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
Jan 1 code/fee update |
| Source locator |
## Commercial and marketplace products → BCBSIL commercial |
UHC commercial
| Record |
Payer and scope |
Status |
| r-d1fc715195 |
UnitedHealthcare · Commercial / plan specific · National / plan specific |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current policies: speech reimbursement policy and habilitation/rehabilitation medical policy. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current policies: speech reimbursement policy and habilitation/rehabilitation medical policy. |
| Next verification |
Verify timed units, same-day edits and new-code rates in the applicable commercial product. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
speech reimbursement policy · habilitation/rehabilitation medical policy |
| Source locator |
## Commercial and marketplace products → UHC commercial |
Aetna commercial
| Record |
Payer and scope |
Status |
| r-b943e51c41 |
Aetna · Commercial / plan specific · National / plan specific |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current policy: Speech Therapy CPB 0243, with separate SGD 0437 and Dysphagia 0625. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current policy: Speech Therapy CPB 0243, with separate SGD 0437 and Dysphagia 0625. |
| Next verification |
Compare developmental/habilitative, AAC and feeding cases to actual benefits; request 2027 code/unit/PA/rate guidance. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
Speech Therapy CPB 0243 · SGD 0437 · Dysphagia 0625 |
| Source locator |
## Commercial and marketplace products → Aetna commercial |
Cigna Healthcare
| Record |
Payer and scope |
Status |
| r-4d2d3fbda4 |
Cigna · Commercial / plan specific · National / plan specific |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current AAC policy: Speech Generating Devices 0049, effective Jan 15, 2026; policy index. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current AAC policy: Speech Generating Devices 0049, effective Jan 15, 2026; policy index. |
| Next verification |
Separate device coverage from SLP treatment; ask for speech therapy and 2027 billing rules by product. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
Speech Generating Devices 0049, effective Jan 15, 2026 · policy index |
| Source locator |
## Commercial and marketplace products → Cigna Healthcare |
Molina Healthcare of Illinois · ACA
| Record |
Payer and scope |
Status |
| r-0f1fd11774 |
Molina Illinois · Marketplace · IL |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current product entry: Illinois marketplace provider resources. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current product entry: Illinois marketplace provider resources. |
| Next verification |
Confirm ACA network, authorization and rates separately from Molina Medicaid. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
Illinois marketplace provider resources |
| Source locator |
## Commercial and marketplace products → Molina Healthcare of Illinois · ACA |
Ambetter of Illinois
| Record |
Payer and scope |
Status |
| r-3e390b140a |
Ambetter IL · Marketplace · IL |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current policy: IL clinical/payment policies list CP.MP.49 for PT/OT/SLP. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current policy: IL clinical/payment policies list CP.MP.49 for PT/OT/SLP. |
| Next verification |
Check the Illinois marketplace PA list and 2027 code/rate mapping; Centene policy does not itself establish contracted payment. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
IL clinical/payment policies |
| Source locator |
## Commercial and marketplace products → Ambetter of Illinois |
Oscar Health Plan of Illinois
| Record |
Payer and scope |
Status |
| r-33232d3816 |
Oscar Illinois · Marketplace · IL |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current entry: provider policies and PA list; Oscar lists 2026 Illinois plans. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current entry: provider policies and PA list; Oscar lists 2026 Illinois plans. |
| Next verification |
Check member-specific network, telehealth and therapy PA before using new codes. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
provider policies · PA list · 2026 Illinois plans |
| Source locator |
## Commercial and marketplace products → Oscar Health Plan of Illinois |
Health Alliance / Carle Health
| Record |
Payer and scope |
Status |
| r-94ba598890 |
Health Alliance · Commercial / plan specific · IL |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current entry: clinical policy guidelines; regional product. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current entry: clinical policy guidelines; regional product. |
| Next verification |
Confirm whether a family has this plan and request the speech policy, PA and code allowances for that product. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
clinical policy guidelines |
| Source locator |
## Commercial and marketplace products → Health Alliance / Carle Health |
MercyCare Health Plans
| Record |
Payer and scope |
Status |
| r-1ecf86f503 |
MercyCare Illinois · Commercial / plan specific · IL |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current entry: medical policies state the member plan determines coverage; Illinois large-group product includes speech therapy. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current entry: medical policies state the member plan determines coverage; Illinois large-group product includes speech therapy. |
| Next verification |
Verify Illinois group/benefit terms. Do not use a Wisconsin 2027 benefit guide as Illinois evidence. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
medical policies · Illinois large-group product |
| Source locator |
## Commercial and marketplace products → MercyCare Health Plans |
UHC Medicare Advantage
| Record |
Payer and scope |
Status |
| r-6f9e888e1b |
UnitedHealthcare · Medicare Advantage · National / plan specific |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current entry: MA medical-policy index includes rehabilitation therapy. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current entry: MA medical-policy index includes rehabilitation therapy. |
| Next verification |
Separate MA rules from UHC commercial; check product PA and new-code adoption if applicable. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
MA medical-policy index |
| Source locator |
## Medicare, federal programs, and self-funded plans → UHC Medicare Advantage |
Cigna Medicare
| Record |
Payer and scope |
Status |
| r-c744b8d13b |
Cigna · Medicare Advantage · National / plan specific |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current entry: Cigna policy index is a commercial coverage position, not proof of Medicare applicability. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current entry: Cigna policy index is a commercial coverage position, not proof of Medicare applicability. |
| Next verification |
Obtain exact MA plan/provider rules before extrapolating AAC or speech criteria. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
Cigna policy index |
| Source locator |
## Medicare, federal programs, and self-funded plans → Cigna Medicare |
Humana Medicare Advantage
| Record |
Payer and scope |
Status |
| r-9285fe6382 |
Humana · Medicare Advantage · National / plan specific |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current entry: medical coverage policies and PA lookup. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current entry: medical coverage policies and PA lookup. |
| Next verification |
Check member plan and 2027 code, rate and therapy authorization treatment; pediatric volume may be limited. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
medical coverage policies · PA lookup |
| Source locator |
## Medicare, federal programs, and self-funded plans → Humana Medicare Advantage |
NGS Medicare Part B
| Record |
Payer and scope |
Status |
| r-f9ec572e87 |
NGS Medicare · Medicare Part B · National / plan specific |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Verified correction: Illinois is Jurisdiction 6, not Jurisdiction K (CMS J6 contractor listing). |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Verified correction: Illinois is Jurisdiction 6, not Jurisdiction K (CMS J6 contractor listing). |
| Next verification |
Watch CMS final 2027 fee schedule and J6 instructions; Medicare is a benchmark, not a pediatric commercial rate. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
CMS J6 contractor listing |
| Source locator |
## Medicare, federal programs, and self-funded plans → NGS Medicare Part B |
TRICARE West · TriWest
| Record |
Payer and scope |
Status |
| r-aa15048000 |
TRICARE · Military health · National / plan specific |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current coverage/route: TRICARE speech therapy, updated Oct 1, 2026; TriWest referrals and authorizations. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current coverage/route: TRICARE speech therapy, updated Oct 1, 2026; TriWest referrals and authorizations. |
| Next verification |
Confirm referral/authorization and new-code handling for Illinois military families. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
TRICARE speech therapy · TriWest referrals and authorizations |
| Source locator |
## Medicare, federal programs, and self-funded plans → TRICARE West · TriWest |
VA CCN Region 2 · Optum
| Record |
Payer and scope |
Status |
| r-01bdd160eb |
VA CCN · VA community care · National / plan specific |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current route: VA says Illinois is Region 2 and claims follow authorization/TPA. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current route: VA says Illinois is Region 2 and claims follow authorization/TPA. |
| Next verification |
Low pediatric priority; keep separate from TRICARE and verify VA referral and coding if a case arises. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
VA says Illinois is Region 2 · claims follow authorization/TPA |
| Source locator |
## Medicare, federal programs, and self-funded plans → VA CCN Region 2 · Optum |
FEHB · BCBS FEP
| Record |
Payer and scope |
Status |
| r-c0ba09e7c0 |
BCBSIL · Commercial / plan specific · IL |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
Current benefit reference: 2026 FEP Blue Focus brochure has its own therapy benefits and visit limits. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
Current benefit reference: 2026 FEP Blue Focus brochure has its own therapy benefits and visit limits. |
| Next verification |
Identify Standard, Basic or Focus and plan year; obtain 2027 brochure and code rules. Do not assume BCBSIL commercial terms. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
2026 FEP Blue Focus brochure |
| Source locator |
## Medicare, federal programs, and self-funded plans → FEHB · BCBS FEP |
UMR
| Record |
Payer and scope |
Status |
| r-1a97b39f75 |
UMR · Employer plan / TPA · National / plan specific |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
TPA: UHC identifies UMR as self-funded administrator; UMR PA tool varies by group plan. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
TPA: UHC identifies UMR as self-funded administrator; UMR PA tool varies by group plan. |
| Next verification |
Get employer plan document and member-specific PA/coding answer; UHC commercial rules may not govern. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
UHC identifies UMR as self-funded administrator · UMR PA tool |
| Source locator |
## Medicare, federal programs, and self-funded plans → UMR |
Allied Benefit Systems
| Record |
Payer and scope |
Status |
| r-70f0af140a |
Allied Benefit Systems · Employer plan / TPA · National / plan specific |
Code/rate/crosswalk verification open |
| Field |
Evidence |
| Summary |
TPA: provider resources and network explanation describe self-insured group variation. |
| Services |
SLP |
| Last checked |
2026-10-09 |
| Dates |
No verified event date |
| Verified reference |
TPA: provider resources and network explanation describe self-insured group variation. |
| Next verification |
Identify employer, network and plan document before drawing a therapy coverage or 2027 crosswalk conclusion. |
| 2027 code adoption |
Not verified by product |
| New-code allowance |
Not verified by product |
| Authorization crosswalk |
Not verified by product |
| Timed units / add-ons |
Not verified by product |
| Same-day edits |
Not verified by product |
| Applicability |
SLP watch; other services require separate verification |
| Source |
provider resources · network explanation |
| Source locator |
## Medicare, federal programs, and self-funded plans → Allied Benefit Systems |
SLP
| Record |
Payer and scope |
Status |
| r-dad083e44d |
Shared billing reference · Commercial / plan specific · National / plan specific |
Apply exact payer/product rule |
| Field |
Evidence |
| Summary |
Speech-code adoption, timed base/add-on documentation, voice/fluency/language service distinctions, cognitive/swallowing/AAC policy and prior-approval conversion. |
| Services |
SLP |
| Last checked |
2026-10-08 |
| Dates |
No verified event date |
| Question or rule |
Speech-code adoption, timed base/add-on documentation, voice/fluency/language service distinctions, cognitive/swallowing/AAC policy and prior-approval conversion. |
| Source |
Source needed |
| Source locator |
## Questions by service → SLP |
Audiology
| Record |
Payer and scope |
Status |
| r-09f8a6f70e |
Shared billing reference · Commercial / plan specific · National / plan specific |
Apply exact payer/product rule |
| Field |
Evidence |
| Summary |
Hearing-test/rehabilitation codes, hearing-aid benefit, device versus professional-service reimbursement, diagnosis and same-day testing edits. |
| Services |
Audiology |
| Last checked |
2026-10-08 |
| Dates |
No verified event date |
| Question or rule |
Hearing-test/rehabilitation codes, hearing-aid benefit, device versus professional-service reimbursement, diagnosis and same-day testing edits. |
| Source |
Source needed |
| Source locator |
## Questions by service → Audiology |
Rates / crosswalks
| Record |
Payer and scope |
Status |
| r-77c790ece2 |
Shared billing reference · Commercial / plan specific · National / plan specific |
Apply exact payer/product rule |
| Field |
Evidence |
| Summary |
Written code-specific allowance and authorization conversion needed by product. Generic adoption notices do not provide either. |
| Services |
SLP, Audiology |
| Last checked |
2026-10-08 |
| Dates |
No verified event date |
| Question or rule |
Written code-specific allowance and authorization conversion needed by product. Generic adoption notices do not provide either. |
| Source |
Source needed |
| Source locator |
## Verified billing rules and gaps → Rates / crosswalks |
Diagnosis / same day
| Record |
Payer and scope |
Status |
| r-d56611a178 |
Shared billing reference · Commercial / plan specific · National / plan specific |
Apply exact payer/product rule |
| Field |
Evidence |
| Summary |
Capture exact diagnosis, benefit category, procedure pair, provider/discipline, setting, modifiers, edit version and denial/remittance. |
| Services |
SLP, Audiology |
| Last checked |
2026-10-08 |
| Dates |
No verified event date |
| Question or rule |
Capture exact diagnosis, benefit category, procedure pair, provider/discipline, setting, modifiers, edit version and denial/remittance. |
| Source |
Source needed |
| Source locator |
## Verified billing rules and gaps → Diagnosis / same day |
Pediatric Medicaid
| Record |
Payer and scope |
Status |
| r-4061373642 |
Shared billing reference · Commercial / plan specific · National / plan specific |
Apply exact payer/product rule |
| Field |
Evidence |
| Summary |
Reconcile HFS notices/EPSDT, exact MCO clinical criteria and actual claim/authorization configuration. |
| Services |
SLP, Audiology |
| Last checked |
2026-10-08 |
| Dates |
No verified event date |
| Question or rule |
Reconcile HFS notices/EPSDT, exact MCO clinical criteria and actual claim/authorization configuration. |
| Source |
Source needed |
| Source locator |
## Verified billing rules and gaps → Pediatric Medicaid |
ASHA transition resources announced October 9 2026
Published October 9, 2026 · checked October 13 · national professional guidance. ASHA announced refreshed resources following AMA’s release of the 2027 code book: a coding readiness checklist, treatment coding quick guide, payer code-use tracker, template payer letter and code-by-code videos.
Practical use: Map services and direct treatment time to the correct base/add-on pair, review documentation and billing-system configuration, and record each payer’s acceptance date, authorization requirements, billing expectations and payment rates separately. ASHA’s resources do not establish a payer’s adoption or contracted allowance. Medicare final values remain dependent on the final 2027 payment rule.
ASHA October 9 announcement — Transition resources · Current implementation resources and downloads
