Reimbursement for speech therapy treatment
As a speech therapist, you will find information here about article 36 of the nomenclature.
This article determines the conditions for reimbursement for speech therapy treatments.
Application procedure
Speech therapy (assessment and treatment) is only reimbursed if the CM consulting physician approves. But what exactly do you need to do? Follow the steps.
The doctor will prescribe the patient for the initial assessment (testing). The doctor in question must have an active INAMI number.
The speech therapist carries out the assessment.
A qualified medical specialist will prescribe the treatment.
The speech therapist provides CM with the necessary documents:
- the application form for compensation completed, dated and signed by the speech therapist and the patient or his legal representative
- the medical prescription for the initial assessment
- the medical prescription for speech therapy treatment
The initial assessment is kept in the patient file.
The speech therapist starts the treatment.
Guidelines for a balance sheet
A bilan is always typed and contains the following elements :
- identification of the speech therapist and the patient;
- description of the balance sheet (nature, date and place of preparation);
- identification of the disorder for which reimbursement is requested;
- description of the problem;
- research data;
- therapy proposal;
- signature of the speech therapist.
A balance sheet in the context of learning disabilities (B3) must also contain the following information:
- anamnesis (current school year of the child with his or her teaching age, school career and language situation);
- evaluation specific to the disorder (dyslexia, dysorthographia, dyscalculia).
Refund exclusions
There is no reimbursement by health insurance for speech therapy if the person entitled :
- follows special education (this restriction only applies to treatments provided for under §2, b), 2°; §2, b), 3° and §2, f);
- is treated and/or housed in an institution recognised and subsidised by the communities/regions, where the function of speech therapist is included in the recognition standards;
- has been admitted for nursing in a service that is recognized under the letters G, T, A, Sp or K;
- resides in a PVT, ROB or RVT;
- is rehabilitating in an institution that has concluded an agreement with the National Institute for Health and Disability Insurance (INAMI) or with the federated entities that covers treatment by a speech therapist (this exclusion does not apply to beneficiaries with disorders described in §2, b), 6°, 6.3 and §2, d).
For information: Interpretation rule no. 8 clarifies the prohibition on combining monodisciplinary and multidisciplinary treatment. More information on this can be found on the INAMI website .
A refund is also excluded for disorders resulting from :
- psychiatric disorders or emotional states:
- relationship problems;
- neglected or inadequate school attendance (e.g. due to illness);
- learning a language other than the mother tongue or a multilingual upbringing;
- simple disorders such as sigmatism, rhotacism, lambdacism, kappacism, cluttering;
- voice disorders such as acute functional aphonia or dysphonia, phonasthenia, voice alternating disorders;
- disorders provided for under §2, b) and 2°) that follow speech therapy for dyslexia and/or dysorthography and/or dyscalculia.
Parental guidance
Through parental guidance, those raising the child are taught practical strategies to effectively support the child's speech therapy treatment.
No separate application to the consulting physician is required for this parental guidance.
Parental guidance can be certified for the following disorders:
- B2: Disorders in receptive and/or expressive language development
- B3: Dyslexia and/or dysorthography and/or dyscalculia
- B6.4: Stuttering
- C2: Dysfunction of the larynx and/or vocal folds
- D: Hearing disorders
- F: Dysphasia
These services may be charged a maximum of ten times per disorder per child, spread over the duration of the treatment.
The maximum number of treatment sessions for the disorder must be reduced by the number of parental guidance sessions charged. There are individual and group sessions:
- an individual parental guidance session is equated to two individual treatment sessions of thirty minutes;
- A collective parental guidance session is equated to an individual treatment session of thirty minutes.
Relapse
From 1 August 2024: abolition of all provisions concerning the relapse assessment and treatment in the event of relapse.