BlueCross and BlueShield of Montana Medical Policy/Codes
Speech Generating Devices (SGD)
Chapter: Durable Medical Equipment
Current Effective Date: December 27, 2013
Original Effective Date: December 27, 2013
Publish Date: September 27, 2013
Description

Speech Generating Devices (SGDs) are defined as speech aids that provide individuals with severe speech impairment the ability to meet their functional speaking needs.  Devices that meet the definition of SGDs:

  • Are dedicated speech devices, used solely by the individual who has a severe speech impairment.
  • May have digitized speech output, using pre-recorded messages, less than or equal to 8 minutes recording time.
  • May have digitized speech output, using pre-recorded messages, greater than 8 minutes recording time.
  • May have synthesized speech output, which requires message formulation by spelling and device access by physical contact with the device-direct selection techniques.
  • May have synthesized speech output, which permits multiple methods of message formulation and multiple methods of device access.
  • May be software that allows a laptop computer, desktop computer or personal digital assistant (PDA) to function as a speech generating device.

Examples of devices that would not meet the definition of SGDs include:

  • Devices that are not dedicated speech devices, but are devices that are capable of running software for purposes other than for speech generation, e.g., devices that can also run a word processing package, an accounting program, or perform other non-medical function.
  • Laptop computers, desktop computers, or PDAs, which may be programmed to perform the same function as a speech generating device, are non-covered since they are not primarily medical in nature and do not meet the definition of durable medical equipment.
  • A device that is useful to someone without severe speech impairment is not considered a speech generating device.

Speech-Language Pathologists (SLPs) are licensed health professionals educated at the graduate level in the study of human communication, its development and its disorders.  An SLP holds a Certificate of Clinical Competence (CCC) in speech-language pathology from the American Speech-Language-Hearing Association.

Digitized speech, sometimes referred to as a device with whole message speech output, utilizes words or phrases that have been recorded by an individual other than the SGD user for playback upon command of the SGD user.

Synthesized speech, unlike the pre-recorded messages of digitized speech, is a technology that translates a user's input into device-generated speech.  Users of synthesized speech SGDs are not limited to re-recorded messages but rather can independently create messages as their communication needs dictate.

Personal Digital Assistants 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.

Speech generating software programs enable a laptop computer, desktop computer or PDA to function as an SGD.  Within this policy, the term SGD also describes these speech generating software programs.

Accessories for speech generating devices include, but are not limited to, access devices that enable selection of letters, words or symbols via direct or indirect selection techniques.  Examples of access devices include optical head pointers, joysticks, switches, wheelchair integration devices and SGD scanning devices.  In addition, replacement accessories such as batteries, battery chargers and AC adapters are also included as accessories.

Mounting systems are devices necessary to place the SGD device, switches, and other access devices within reach of the patient.

Accessories for SGDs include, but are not limited to access devices that enable selection of letters, words, or symbols via direct or indirect selection techniques.  Examples of access devices include, but are not limited to:

  • Optical head pointers,
  • Joysticks,
  • Switches,
  • Wheelchair integration devices,
  • SGD scanning devices, and
  • Replacement accessories, such as batteries, battery chargers, AC adapters, etc.
Policy

Each benefit plan or contract defines which services are covered, which are excluded, and which are subject to dollar caps or other limits.  Members and their providers have the responsibility for consulting the member's benefit plan or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply.  If there is a discrepancy between a Medical Policy and a member's benefit plan or contract, the benefit plan or contract will govern.

Coverage

A speech generating device (SGD) may be considered medically necessary when ALL the following criteria are met:

  • Prior to delivery of the 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, all of the following elements:
    1. Current communication impairment, including the type, severity, language skills, cognitive ability, and anticipated course of the impairment;
    2. An assessment of whether the individual's daily communication needs could be met using other natural modes of communication (gestural, speech, and/or written communication);
    3. A description of the functional communication goals expected to be achieved and the treatment options;
    4. Rationale for selection of a specific device and any accessories;
    5. Demonstration that the patient possesses a treatment plan that includes a training schedule for the selected device;
    6. Patient has the cognitive and physical abilities to effectively use the selected device and any accessories to communicate;
    7. Any request for upgrading from a previously issued SGD must provide information regarding the functional benefit to the patient of the upgrade compared to the original device; AND
  • The patient's medical condition is one resulting in a severe expressive speech impairment; AND
  • The patient's speaking needs cannot be met using gestural, speech, and/or written communication; AND
  • Other forms of treatment have been considered and ruled out; AND
  • The patient will gain intelligible speech with the device despite the patient's severe communication impairment demonstrated by a one month trial therapy utilizing the device prior to purchase; AND
  • A copy of the SLP's written evaluation and recommendation must be forwarded to the patient's treating physician prior to ordering the device; AND
  • The SLP performing the patient evaluation may not be an employee of or have a financial relationship with the supplier of the SGD.

Software that enables a laptop computer, desktop computer or personal digital assistant (PDA) to function as an SGD may be considered medically necessary as an SGD.

Accessories and upgrades may be considered medically necessary if the coverage criteria are met and documentation supporting the medical necessity is clearly documented in the evaluation by the SLP.

An SGD is considered not medically necessary for any of the following:

  • Situations in which any one or more of the SGD coverage criteria listed above is not met; or
  • Laptop computers, desktop computer, PDAs, or other devices that are not dedicated SGDs; or
  • More than one SGD.

Communication aids that are not SGDs are considered not medically necessary as they:

  • are not prosthetics for speech,
  • do not replace all or part of a body organ,
  • do not replace all or part of the function of a permanently inoperative, absent, or malfunctioning body part. 

Examples of non-covered communication aids include, but are not limited to, the following:

  • Picture books,
  • Flash cards,
  • Braille typewriters,
  • Text telephone or telecommunication device for the deaf (TDD),
  • Devices that allow the patient to communicate messages to others with writing (e.g., a display screen or printout) rather than synthesized speech,
  • Devices that allow the user to communicate with a computer rather than with another person.

Policy Guidelines

Speech generating devices include the device, any applicable software, batteries, battery chargers, and AC adapters.  These items are not reimbursed separately.   However, batteries, battery chargers, and AC adaptors would be considered replacement accessories and allowed for reimbursement when billed alone for replacement purposes.

Speech generating software programs are not reimbursed separately at the initial provision of the SGD since the software cost is included in the SGD reimbursement.  Also, there should be no separate billing of any software, interfaces, cables, adapters, interconnects, or switches necessary for the accessory to interface with the SGD.

Rationale

Speech generating devices have been proven to be valuable tools to aid individuals with severe speech impairment.  This policy is based on Medicare DMERC coverage criteria for speech generating devices.

2013 Update

A search of peer reviewed literature through July 2013 identified no new information that would change the coverage position of this medical policy.

Coding

Disclaimer for coding information on Medical Policies

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers. Only the written coverage position in a medical policy should be used for such determinations.

Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member’s benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps.

ICD-9 Codes

Refer to the ICD-9-CM manual.

ICD-10 Codes

Refer to the ICD-10-CM manual.

Procedural Codes: 92609, E1902, E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512, E2599
References
  1. CMS—National Coverage Determination for Speech Generating Devices (50.1) (2001 January 1) Centers for Medicare and Medicaid Services.  Available at http://www.cms.hhs.gov (accessed 2013 July 19).
  2. CMS—Local Coverage Determination for Speech Generating Devices (L11524) (2011 August 5) Centers for Medicare and Medicaid Services.  Available at http://www.cms.hhs.gov (accessed 2013 July 19).
  3. American Speech-Language-Hearing Association. (2002). Augmentative and alternative communication: knowledge and skills for service delivery.  ASHA Supplement 22, 97-106.
History
September 2013  New 2013 BCBSMT medical policy.
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Speech Generating Devices (SGD)