Appeal type: Medical necessity
Decision: Upheld

Diagnosis: Mixed Expressive-Receptive Language Disorder 
Treatment: 92507 - Treatment of speech, language, voice, communication, and/or auditory processing disorder, individual for dates of service for four dates of service 

The 92507 - Treatment of speech, language, voice, communication, and/or auditory processing disorder, individual for all four dates of service is not medically necessary. 

(Central) Auditory Processing Disorder (APD) is a controversial and unproven entity in which individuals are purported to have difficulty processing or interpreting auditory information. [JCIH 2013, Yoshinaga-Itano 2014] 

These patients have normal hearing.  Children diagnosed with APD often do not recognize subtle differences between sounds in words, even though the sounds themselves are loud and clear.  These problems occur more frequently in noisy environments or when listening to complex information.  Thus, another common name for this entity is "word deafness."  A review of the peer-reviewed medical literature finds mostly poorly designed studies, small studies, flawed methodology, or short-term follow up.  

Although the American Speech-Language-Hearing Association published a Technical Report on APD in 2005, it is based on theory and opinion.  It is not evidence-based.  Since the 1960s, APD remains a modality-specific diagnosis (i.e., one made by audiologists or speech-language pathologists).  Rather than being a standalone diagnosis, APD is always part of a "bigger picture," including attention-deficit/hyperactivity disorder, autism spectrum disorder, learning disability (e.g., dyslexia), or language disorder.  There are no adequate controlled studies either supporting the existence of APD as a distinct and definable entity or clearly demonstrating the effectiveness of APD therapy compared to placebo.  Research has consistently failed to uncover any sound scientific evidence that APD therapy produces meaningful outcomes for people with developmental disorders.  Well-designed scientific studies are needed to determine whether APD is indeed a disorder, and if so, whether therapy is effective or necessary.  Until then, APD and its treatments remain unproven.  

In 2015, deBonis reviewed the current literature and concluded the following: "(a) Current testing of CAPD is highly influenced by nonauditory factors, including memory, attention, language, and executive function; (b) the lack of agreement regarding the performance criteria for diagnosis is concerning; (c) the contribution of auditory processing abilities to language, reading, and academic and listening abilities, as assessed by current measures, is not significant; and (d) the effectiveness of auditory interventions for improving communication abilities has not been established."  This indicates that APD is not a valid standalone diagnosis and that treatment for it is ineffective.  

In summary, research has consistently failed to uncover any sound scientific evidence to support APD as a valid, standalone medical diagnosis or that treatment for APD produces meaningful outcomes. Thus, evaluation for or treatment of APD is not medically necessary, appropriate, or standard of care.