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Referral Form for Medical Providers

As a convenience for medical providers ordering speech therapy, TheraVolve Wellness Co. provides a referral form. It is required that the form specify: voice, swallow, or speech therapy evaluation and treatment with diagnosis, together with CPT Evaluation and Treatment Codes (below).

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Please include any additional relevant medical records that will assist us in completing a comprehensive assessment so that we may prepare a recommended plan of care for review and approval by the prescribing physician/medical provider. Patient treatment will begin after physician approval has been received. 

Relevant Evaluation & CPT Codes

  • CPT 92524 | Behavioral and Qualitative Analysis of Voice and Resonance

  • CPT 92610 | Clinical Swallow Evaluation 92610

  • CPT 97129 & 97130 Each 15 minutes| Development of cognitive skills to improve attention, memory, problem solving, direct one-on-one patient contact by the provider 

  • CPT 92522 | Evaluation of speech sound production (i.e., articulation, dysarthria)

  • CPT 92523 | Evaluation of speech sound production (e.g., articulation, dysarthria, expressive and receptive language)

  • CPT 92520 | Laryngeal Function Studies (Acoustic assessment)

  • CPT 92507 | Speech Therapy

  • CPT 92526 | Swallowing Therapy

  • CPT 96125 | Standard Cognitive Performance Testing

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