Neurodevelopmental Therapy—90%

Services and Supplies Must Be Preauthorized With the Trust Office
Benefits are provided for medically necessary neurodevelopmental therapy prescribed by a physician to restore and improve function for children age six and under. There is an annual maximum benefit of 15 visits. If charges for more than 15 visits are submitted, those charges will be denied. This benefit includes maintenance services for identifiable underlying causes when significant deterioration of the child's condition would result without the service. The child's physician must preauthorize treatment with the Trust Office and must periodically review the written treatment plan specifically describing the neurodevelopmental therapy services provided. Progress notes may be required by the Trust Office.

Benefits are provided for physical, speech, and occupational therapy when performed by a physician or a physical, speech, or occupational therapist in the office, clinic, or outpatient hospital department.

Benefits are not provided for:

1. Custodial or maintenance care; nonmedical self-help or related testing; recreational, educational, cognitive, behavioral, or vocational therapy; feeding therapy; hippotherapy; routine developmental screening exams; gym or pool therapy; or sensory processing/integration therapy.
2. Speech therapy for self-correcting dysfunction such as hoarseness or language therapy for young children with natural dysfluency; oral myofunctional therapy; stammering and stuttering; or tongue thrust. Developmental articulation errors that are self-correcting are also not covered.
3. State-required medical assessments for specialized educational programs; services or supplies required by law to be provided by any school system; or treatment for learning disabilities. This exclusion applies regardless of the recommendation of the attending physician.
4. Neurodevelopmental therapy, autism spectrum therapy, and rehabilitative care for the same condition.