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Date Printed: June 23, 2017: 06:33 PM

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This medical policy (medical coverage guideline) is Copyright 2017, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2017 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association. The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

09-E0000-51

Original Effective Date: 07/15/04

Reviewed: 06/25/09

Revised: 05/15/14

Subject: Speech Generating Devices (e.g., Dynavox)

THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. ALL MEDICAL DECISIONS ARE SOLELY THE RESPONSIBILITY OF THE PATIENT AND PHYSICIAN. BENEFITS ARE DETERMINED BY THE GROUP CONTRACT, MEMBER BENEFIT BOOKLET, AND/OR INDIVIDUAL SUBSCRIBER CERTIFICATE IN EFFECT AT THE TIME SERVICES WERE RENDERED. THIS MEDICAL COVERAGE GUIDELINE APPLIES TO ALL LINES OF BUSINESS UNLESS OTHERWISE NOTED IN THE PROGRAM EXCEPTIONS SECTION.

Position Statement Billing/Coding Reimbursement Program Exceptions Definitions Related Guidelines
Other References Updates  

DESCRIPTION:

Speech generating devices, also known as augmentative communication devices, are electronic devices used for communication by individuals that do not have the ability to speak. These individuals typically have a diagnosis of severe apraxia, aphasia, aphonia, and/or dysarthria, which may be secondary to motor dysfunction, spasticity, tremor, rigidity, or ataxia. Their disability may result from a disease or congenital disorder, such as cerebral palsy (CP), stroke, progressive amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), muscular dystrophy (MD), traumatic or congenital quadriplegia, or traumatic brain injury (TBI).

Speech generating devices are used therapeutically to establish, develop, or maintain the ability to communicate functional needs. These devices or aids are electronic, usually computer-assisted devices. The user inputs letters, words, or phrases to generate synthesized speech and/or printed text. Examples of the many types of these devices include the AlphaTalker™, DeltaTalker™, DynaMyte, and DynaVox. These devices can generate synthesized (e.g. computer-generated) and/or digitized (natural human) speech output.

Personal digital assistants (PDAs) are handheld devices that integrate the functions of a small computer with features such as a cell phone, personal organizer, electronic mail or pager. Information may be input via a pen-based system using a stylus and handwriting recognition software, keyboard or downloaded from a personal computer using special cables and software.

POSITION STATEMENT:

Speech generating devices (SGD) meet the definition of medical necessity when ALL of the following criteria (1 – 7) are met:

  1. Prior to the delivery of the speech-generating device (SGD), the patient has had a formal evaluation of their cognitive and communication abilities by a speech-language pathologist (SLP). The formal, written evaluation must include, at a minimum, the following elements:
  1. The patient's medical condition is one resulting in a severe expressive speech impairment; AND
  2. The patient's speaking needs cannot be met using natural communication methods; AND
  3. Other forms of treatment have been considered and ruled out; AND
  4. The patient's speech impairment will benefit from the device ordered; AND
  5. A copy of the SLP's written evaluation and recommendation have been forwarded to the patient's treating physician prior to ordering the device; AND
  6. The SLP performing the patient evaluation is not an employee of or does not have a financial relationship with the supplier of the SGD.

Software that enables a laptop computer, desktop computer, or PDA to function as a speech-generating device is covered as an SGD.

Accessories for speech-generating devices include, but are not limited to, access devices that enable selection of letters, words, or symbols by direct or indirect selection techniques. Examples of access devices may include optical head pointers, joysticks, switches, wheelchair integration devices and speech generating device scanning devices. These accessories are covered if the basic coverage criteria for the base device are met and the medical necessity for each accessory is clearly documented in the formal SLP evaluation.

NOTE: If one or more of the SGD coverage criteria 1 – 7 is not met, the SGD will be denied as does not meet the definition of medical necessity.

Claims for more than one SGD will be denied as does not meet the definition of medical necessity as the additional SGD would be considered primarily for convenience.

Laptop computers, desktop computers, PDAs or other devices that are not dedicated SGDs are not covered as they do not meet the definition of durable medical equipment (DME).

BILLING/CODING INFORMATION:

HCPCS Coding

E2500

Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 minutes recording time

E2502

Speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes, but less than or equal to 20 minutes recording time

E2504

Speech generating device, digitized speech, using pre-recorded messages, greater than 20 minutes, but less than or equal to 40 minutes recording time

E2506

Speech generating device, digitized speech, using pre-recorded 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

E2511

Speech generating software program, for personal computer or personal digital assistant

E2512

Accessory for speech generating device, mounting system

E2599

Accessory for speech generating device, not otherwise classified

REIMBURSEMENT INFORMATION:

Reimbursement for the following services or accessories is included in the rental or purchase allowance for the speech generating device:

For coverage and reimbursement for repairs and replacement of these devices, refer to MCG Durable Medical Equipment (DME), 09-E0000-01.

PROGRAM EXCEPTIONS:

Federal Employee Program (FEP): Follow FEP guidelines.

State Account Organization (SAO): Follow SAO guidelines.

Medicare Advantage products:

The following National Coverage Determination (NCD) was reviewed on the last guideline reviewed date: Speech Generating Devices (50.1) located at cms.gov.

The following Durable Medical Equipment Regional Carrier (DMERC) Local Coverage Determination (LCD) was reviewed on the last guideline reviewed date: Speech Generating Devices (L11524) located at cgsmedicare.com.

DEFINITIONS:

No guideline specific definitions apply.

RELATED GUIDELINES:

Durable Medical Equipment (DME), 09-E0000-01
Prosthetics, 09-L0000-05

OTHER:

None Applicable.

REFERENCES:

  1. American Speech-Language-Hearing Association. Roles and Responsibilities of Speech-Language Pathologists With Respect to Augmentative and Alternative Communication: Position Statement (2005).
  2. American Speech-Language-Hearing Association. Roles and Responsibilities of Speech-Language Pathologists With Respect to Augmentative and Alternative Communication: Technical Report (2004).
  3. American Speech-Language-Hearing Association. Roles and Responsibilities of Speech-Language Pathologists With Respect to Augmentative and Alternative Communication: Knowledge and Skills for Service Delivery (2002).
  4. Centers for Medicare and Medicaid Services (CMS) National Coverage Determination (NCD) for Speech Generating Devices, Publication 100-3, Section 50.1 (effective date 01/01/01; revised 09/02).
  5. CMS Region C DMERC, Palmetto, TrustSolutions, Local Coverage Determination (LCD) for Speech Generating Devices (L11524) (06/07).
  6. National Institute on Deafness and Other Communication Disorders. Apraxia of Speech. Accessed 06/02/09.
  7. National Institute on Deafness and Other Communication Disorders. Aphasia. Accessed 06/02/09.
  8. St. Anthony’s Level II Coding (current edition).

COMMITTEE APPROVAL:

This Medical Coverage Guideline (MCG) was approved by the BCBSF Medical Policy & Coverage Committee on 06/25/09.

GUIDELINE UPDATE INFORMATION:

07/15/04

New Medical Coverage Guideline.

07/15/06

Scheduled review (consensus review); no changes to coverage statement; references updated.

08/15/07

Review, coverage statements maintained, guideline reformatted, references updated.

07/15/09

Scheduled review; no change in position statement; references updated.

05/15/14

Revision; Program Exceptions section updated.

Date Printed: June 23, 2017: 06:33 PM