Clinical UM Guideline
|Subject:||Augmentative and Alternative Communication (AAC) Devices/Speech Generating Devices (SGD)|
|Guideline #:||CG-DME-07||Current Effective Date:||10/08/2013|
|Status:||Reviewed||Last Review Date:||08/08/2013|
Augmentative and alternative communication (AAC) devices and speech generating devices (SGD) are aids to provide individuals with severe speech impairment or absent speech, the ability to meet their functional communication needs. There may be associated functional disabilities that also limit the individual's ability to use alternative natural methods of communication such as writing notes, using sign language, or even to manipulate a low tech augmentative communication system.
Augmentative and alternative communication and speech generating devices and systems are considered medically necessary when all of the following criteria 1 through 3 are met, and when applicable, criteria 4 or 5 are met:
*Refer to Discussion/General Information section of the clinical guideline for information on high technology and low technology devices
Accessories are considered medically necessary if criteria for the base device are met and the medical necessity for each accessory is clearly documented in the formal evaluation by the speech language pathologist. For any subsequent upgrade of equipment or accessories to a previously issued device, information regarding the functional benefit to the individual of the upgrade compared to the initially provided device must be submitted to demonstrate medical necessity.
When the above criteria 1 through 3 are met, and when applicable, criteria 4 or 5 are met, specific communication software for dedicated speech generating devices is considered medically necessary.
Not Medically Necessary:
Augmentative communication devices and speech generating devices/systems are considered not medically necessary if the above criteria are not met or if they are not primarily and customarily used to serve a medical purpose.
The following would also be considered not medically necessary:
The following codes for treatments and procedures applicable to this document are included below for informational purposes. A draft of future ICD-10 Coding (effective 10/01/2014) related to this document, as it might look today, is included below for your reference. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.
|E1902||Communication board, non-electronic augmentative or alternative communication device|
|E2351||Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface|
|E2500||Speech generating device, digitized speech, using prerecorded messages, less than or equal to 8 minutes recording time|
|E2502||Speech generating device, digitized speech, using prerecorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time|
|E2504||Speech generating device, digitized speech, using prerecorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time|
|E2506||Speech generating device, digitized speech, using prerecorded messages, greater than 40 minutes recording time|
|E2508||Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device|
|E2510||Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access|
|Artificial larynx and accessories|
|L8500||Artificial larynx, any type|
|L8501||Tracheostomy speaking valve|
|L8507||Tracheo-esophageal voice prosthesis, patient inserted, any type, each|
|L8509||Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type|
|ICD-10 Diagnosis||ICD-10-CM draft codes; effective 10/01/2014|
Digitalized speech: Devices with "whole message" speech output utilize words or phrases recorded by another individual.
Laryngectomy: Surgical removal of the voice box.
Speech disorder: A condition affecting the ability to produce normal speech may affect articulation (phonetic or phonological disorders); fluency (stuttering or cluttering); and/or voice (tone, pitch, volume, or speed); most speech disorders have their roots in the muscles of the mouth and/or mouth movements.
Speech language pathologist: Another title for a Speech Therapist.
Synthesized speech: A technology that translates a user's input into device-generated speech.
Peer Reviewed Publications:
Government Agency, Medical Society, and Other Authoritative Publications:
|Web Sites for Additional Information|
Augmentative and Alternative Communication (AAC) Devices
Speech Generating Devices (SGD)
|Reviewed||08/08/2013||Medical Policy & Technology Assessment Committee (MPTAC) review. Updated References and Websites. Added Web Sites for Additional Information section.|
|Revised||08/09/2012||MPTAC review. Clarified not medically necessary statement. Updated Coding, Discussion/General Information, References and Websites.|
|01/01/2012||Updated Coding section with 01/01/2012 CPT changes.|
|Reviewed||08/18/2011||MPTAC review. Updated Coding, References and Websites.|
|Reviewed||08/19/2010||MPTAC review. Updated References and Websites.|
|Reviewed||08/27/2009||MPTAC review. Removed Place of Service Section.|
|Reviewed||08/28/2008||MPTAC review. Formatting corrected in medical necessity section. Separated software criteria and moved into the medical necessity section. Updated coding section with 10/01/2008 ICD-9 changes.|
|Reviewed||08/23/2007||MPTAC review. Formatting corrected in medical necessity section. Updated definitions and references. No change to position.|
|Reviewed||09/14/2006||MPTAC review. No change in position.|
|11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Reviewed||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization.|
Last Review Date
|Anthem West: DME.220||Speech Generating Devices|
|Anthem CT||Durable Medical Equipment Summary of Coverage Criteria Guidelines|
|WellPoint Health Networks, Inc.|
|9.03.05||Augmentative and Alternative Communication (AAC) Devices/Speech Generating Devices (SGD)|