`V5363` Language screening

Language screening

Medicare coverage: Non-covered by statute
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 0 units per day (clinical), rationale: CMS Policy

Medicare pricing for V5363

Physician Fee Schedule (CY 2026, RVU26D)

Status N: non-covered service.

Payer policies and prior authorization for V5363

1 of 1 payer prior-auth lists that name V5363 require prior authorization or set conditions: Humana.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Humana	Humana Healthy Horizons	FL	prior auth required		Jan 1, 2027	1102002FL1026 FLHN8CBEN Humana Healthy Horizons in Florida Preauthorization and Notification List

Payer coverage policies that name V5363

V5363 appears in 4 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Autism Spectrum Disorders (0648)	covered if criteria are met	Oct 2, 2025	payer document
Aetna	Speech Generating Devices (0437)	covered if criteria are met	Jul 1, 2026	payer document
Aetna	Voice Therapy (0646)	listed, no stance	Sep 9, 2026	payer document
Blue Cross & Blue Shield of Rhode Island	Speech Therapy	covered if criteria are met	Aug 5, 2026	payer document

Recent prior-auth changes

Jan 1, 2024: PA removed, humana:pa:commercial

Medicaid fee-for-service

Prior authorization required or conditional in IN.

ND: $0.00 (physician), effective Aug 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

V5363 Language screening