Myofunctional therapy is an evidence-based treatment used to improve tongue posture, nasal breathing, swallowing, and airway stability. It is widely used for sleep-disordered breathing, tongue-tie recovery, TMJ dysfunction, oral dysphagia, mouth breathing, and speech-related concerns.
But when it comes to insurance coverage, families often run into confusing or inconsistent information.

This guide explains how insurers classify myofunctional therapy, which diagnoses apply, what documentation strengthens claims, and how Medicare and Medicaid approach coverage.

How Insurers Classify Myofunctional Therapy

Insurance companies typically do not recognize “myofunctional therapy” as a standalone benefit category.
Instead, coverage flows through one of the following benefit structures:

1. Speech-Language Pathology (SLP) Benefits

Most commonly, myofunctional therapy is billed under:

• Speech therapy
  
• Speech-language pathology services
  
• Swallowing therapy
  
• Cognitive-communication services (rare, specific cases)

Insurers treat myo similarly to exercises that support:

• Oral-motor coordination
  
• Swallowing function
  
• Breathing-speech coordination
  
• Voice and resonance support
  
• Airway-related dysfunction with functional impact

2. Swallowing / Dysphagia Benefits

When myofunctional therapy targets:

• Oral dysphagia
  
• Pharyngeal dysphagia
  
• Tongue thrust
  
• Feeding challenges
  coverage may fall under dysphagia or feeding therapy benefits.

3. Sleep-Related Disorders (Secondary Classification)

For sleep-disordered breathing, therapy is rarely processed under sleep benefits.
Instead, it is supported under:

• SLP benefits
  
• Orthodontic collaboration
  
• Medical necessity tied to airway dysfunction or impaired oral-motor patterns

4. TMJ / Orofacial Myology (Case-by-Case)

TMJ-related therapy is inconsistently covered. Some plans allow visits under:

• Physical therapy
  
• SLP services
  
• Medical necessity for orofacial myofunctional dysfunction

Because each plan is unique, benefit checks are essential.

For insurance details, visit:
/insurance

Diagnoses That Commonly Apply

Insurance plans look primarily at diagnosis codes, not the therapy label.
Common medically necessary diagnoses that relate to myofunctional therapy include:

Breathing & Airway

• Sleep-disordered breathing
  
• Obstructive sleep apnea (when therapy addresses functional contributors)
  
• Upper airway resistance syndrome
  
• Mouth breathing
  
• Nasal obstruction
  
• Deviated septum (functional sequelae)

Swallowing / Feeding

• Oral dysphagia
  
• Pharyngeal dysphagia
  
• Swallowing dysfunction
  
• Tongue thrust
  
• Poor bolus control
  
• Pediatric feeding challenges

Orofacial Myofunctional Disorders

• Low tongue posture
  
• Tongue-tie (pre- and post-frenectomy)
  
• Open-mouth posture
  
• Habitual mouth breathing
  
• Orofacial muscle imbalance

Speech & Articulation

• Distortions related to oral-motor limitations
  
• Speech sound disorders
  
• Resonance imbalance
  
• Limited tongue elevation or coordination

TMJ / Jaw Dysfunction

• TMJ disorder
  
• Bruxism teeth grinding
  
• Jaw instability
  
• Orofacial muscle tension

Coverage depends on how the diagnosis affects function and daily activities.

Documentation: What Strengthens Claims

Clear documentation dramatically increases approval likelihood.

Key documentation includes:

1. Comprehensive SLP Evaluation

Must outline:

• Functional deficits
  
• Oral-motor findings
  
• Breathing or swallowing challenges
  
• Myofunctional dysfunction patterns
  
• Impact on daily life

2. Medical Necessity Statement

Explains why therapy is needed to:

• Improve safety (swallowing, breathing)
  
• Reduce symptoms (airway resistance, mouth breathing, jaw tension)
  
• Prevent deterioration
  
• Support surgical recovery

3. Measurable Goals

Insurers prefer:

• “Patient will achieve sustained tongue-palate contact for 10 seconds…”
  
• “Patient will maintain nasal breathing for daytime and sleep periods…”
  
• “Patient will reduce compensatory jaw recruitment during swallow…”

4. Treatment Plan & Frequency

Includes number of visits and home program expectations.

5. Referrals (When Beneficial)

Although not always required, referrals from:

• ENT
  
• Orthodontist
  
• Pediatrician
  
• Dentist
  can help support medical necessity.

6. Sleep Study or ENT Findings (If Applicable)

Where airway dysfunction is part of the case, these documents strengthen approval.

Medicare & Medicaid Expectations

Coverage for myofunctional therapy through Medicare and Medicaid depends on how services are classified.

Medicare

Medicare covers speech-language pathology when medically necessary.
Myofunctional therapy is covered if:

• It is provided by a licensed SLP,
  
• It addresses a functional impairment (swallowing, breathing-speech coordination, speech),
  
• Goals align with covered SLP services.

Medicare does not cover:

• Habit correction alone
  
• Purely wellness-based myo
  
• Orthodontic-only indications

Medicaid

Medicaid coverage varies by state but is generally more generous for:

• Pediatric speech and feeding therapy
  
• Breathing and swallowing dysfunction
  
• Orofacial myofunctional disorders when they affect daily life

BreatheWorks accepts Medicaid and Medicare at eligible clinics.

FAQ

Is myofunctional therapy always covered?

Not always.
Coverage depends on:

• Diagnosis
  
• Plan type
  
• Medical necessity
  
• Whether therapy is billed under speech-language pathology

Most patients have some coverage, but copays and visit limits vary.

Can patients submit superbills?

Yes.
Patients who are out-of-network or self-pay can submit superbills for partial reimbursement depending on their plan’s out-of-network benefits.

Do you accept Medicare/Medicaid?

Yes—many BreatheWorks locations accept Medicare and Medicaid.
Coverage specifics vary by state and location.
Contact us here:
/contact