Medical Necessity for the Speech Therapist: Step 3

Determine How the Results of the Assessment Impact Functional Performance

This is the final blog post in our series, Medical Necessity for the Speech Therapist. In the last three blog posts, we reviewed medical necessity and the need for standardized and clinical assessment to fully understand a child’s areas of deficit. 

After the standardized and clinical assessment, the therapist determines how the severity of the delay impacts the patient’s functional performance. To justify the need for therapy services to the schools, insurance company, or other funding sources, the therapist must explain how the deficit impacts social and academic performance. 

It can be difficult to separate social and academic skills, so you may need to approach them as a whole. The speech therapist must be able to take the standardized and clinical assessment, and apply the deficit areas to functional performance, so that the payer understands that without speech therapy, the child won’t be able to perform in social and academic areas as same-aged peers. For example, if a child in the fifth grade is unable to articulate the ‘R’ sound, they may be impacted socially by sounding younger than their age, which may cause poor self-esteem and less likely to engage socially with similar-aged peers. This same child may be less likely to read aloud in class or to present orally in class. 

And once you’ve identified the delay’s impact on their lives, you’ll have your completed justification, your “medical necessity,” for therapeutic services, which encompasses everything and is essentially the entire plan of care!

For more information, check out Pediatric Developmental Therapy’s Working Therapist Podcast titled, “Medical Necessity for the Speech Therapist.”