| Durable Medical Equipment Section - Augmentative
Communication Devices and Systems
| Topic: Augmentative
Communication Devices and Systems |
Date of Origin: 09/1998
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| Section: DME |
Policy No: 52 |
| Approved Date: 07/15/2008 |
Effective Date: 09/01/2008 |
| Next Review Date:07/2010 |
IMPORTANT REMINDER
This Medical Policy has been developed through consideration of medical necessity,
generally accepted standards of medical practice, and review of medical literature
and government approval status.
Benefit determinations should be based in all cases on
the applicable contract language. To the extent there are any conflicts
between these guidelines and the contract language, the contract language will
control.
The purpose of medical policy is to provide a guide to coverage. Medical Policy
is not intended to dictate to providers how to practice medicine. Providers
are expected to exercise their medical judgment in providing the most appropriate
care.
Description
Augmentative communication devices and systems (ACD)
are also known as augmentative and alternative communication
devices (ACC), and speech generating devices (SGD).
These devices have been described as a method to restore
the function of speech to the individual with a functional
disability caused by a speech impairment. Augmentative
communication devices can assist the patient who lacks
the ability to communicate with speech, or alternatives
to speech, such as writing and sign language.
The pathophysiology of the speech disorder may involve
spasticity, flaccidity, tremor, rigidity, ataxia or
other motor impairments. These motor impairments may
affect motor control throughout the body, limiting the
individual's ability to use alternative means of communication
such as writing notes, using sign language or manipulating
a low-tech augmentative communication system.
Low technology, non-electronic augmentative communication
devices include boards that use letters, words, phrases
and/or symbols (communication boards), mini boards,
schedule boards and conversation books. They may be
purchased or homemade, or made by the speech therapist.
High technology augmentative communication devices
are electronic and are usually computer based. They
convert the patient's selections (of letters, words,
symbols and/or phrases) into electronic speech. These
devices vary in method of access with direct selection,
or indirect selection by visual and/or auditory scanning
and use of a switch or joy-stick. There are many different
devices, with varying capabilities, on the market.
Speech generating devices create either digitized speech
or synthesized speech. Digitized speech devices use
pre-recorded words or phrases that the user can playback
upon command. Synthesized speech translates a user's
input into device-generated speech using algorithms
representing linguistic rules. Synthesized speech devices
create individualized messages based on input from a
keyboard, touch screen, or other display containing
letters or symbols. Speech generating software programs
enable a laptop computer, desktop computer or personal
digital assistant (PDA) to function as an SGD.
Policy/Criteria
| I. |
Augmentative communication devices
and systems may be considered medically necessary in the treatment of the
functional disability caused by a speech impairment when all of the following
criteria are met: |
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A. |
The augmentative communication
device has been recommended by a therapist who has conducted a thorough
assessment which includes all of the following information: |
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i. |
Medical diagnosis, physiological description
of the underlying disorder, description of functional limitations and prognosis
for improvement |
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ii. |
Documentation of which functional activities
of daily living (ADLs) are expected to significantly improve with use of
the device. |
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iii. |
Medical justification for the augmentative
communication device, and if a high tech ACD is requested, it can be demonstrated
that a low tech communication device or system is inadequate to meet the
individual's medical and health needs |
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iv. |
Therapeutic history: speech, occupational,
physical |
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v. |
Documentation that the individual has tested
the device and has demonstrated both cognitive and motor ability to use
the device. When possible, the device has been initially rented for 1-2
months prior to purchase. |
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vi. |
Expected goals with the ACD |
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vii. |
Plan of care for the ACD: anticipated training
needs, programming needs, evaluations, etc., including what services are
included in the cost of the device |
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B. |
The individual is unable to either
communicate, or learn to communicate, through speech or alternative communication
techniques such as writing, or sign language |
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C. |
The individual and family express
their willingness to use the device |
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D. |
If the individual has a degenerative
disease causing the speech impairment, the augmentative communication device
selected should be capable of modification to meet the individual's anticipated
needs |
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E. |
If the individual is pre-literate,
but it is anticipated that he will be able to learn to read and spell,
the augmentative communication device selected should, in addition to any
symbols, have spelling and text capabilities |
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| Note: Laptop computers, desktop
computers, PDAs or other devices that are not dedicated ACDs, or are capable
of running other software, e.g., word processing, accounting or other non-medical
functions, do not meet the definition of durable medical equipment (DME). |
References
- Blackston, S. Selecting, using, and evaluating communication
devices. In: Galvin, et al, eds. Evaluating, Selecting,
and Using Appropriate Assistive Technology. Gaithersburg,
Maryland: Aspen Publishers, Inc. 1996:97-124
- Dattilo et al. Facilitating conversation through
self-initiated augmentative communication treatment.
J Appl Behav Anal. 1991;24(2):369-78
- Ko, ML et al. Outcome of recommendations for augmentative
communication in children. Child Care Health Dev.
1998;24(3):195-205
- Yorkston KM. Treatment efficacy: dysarthria.
J Speech Hear Res 1996;39(5):S46-57
Cross References
None
| Codes |
Number |
Description |
| CPT |
92605 |
Evaluation for prescription of non-speech generating
augmentative and alternative communication device |
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92606 |
Therapeutic service(s) for the use of non-speech
generating device, including programming and modification |
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92607 |
Evaluation for prescription for speech-generating
augmentative and alternative communication device,
face-to-face with the patient, first hour. |
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92608 |
Evaluation for prescription for speech-generating
augmentative and alternative communication device,
face-to-face with the patient; each additional
30 minutes (List separately in addition to code
for primary procedure) |
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92609 |
Therapeutic services for the use of speech-generating
device, including programming and modification. |
| HCPCS |
E2500 |
Speech generating device, digitized speech using
pre-recorded messages, less than or equal to 8 minutes
recording time |
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E2502 |
Speech generating device, digitized speech using
pre-recorded messages, greater than 8 minutes but
less than or equal to 20 minutes recording time |
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E2504 |
Speech generating device, digitized speech, using
pre-recorded messages, greater than 20 minutes but
less than or equal to 40 minutes recording time |
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E2506 |
Speech generating device, digitized speech, using
pre-recorded messages, greater than 40 minutes recording
time |
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E2508 |
Speech generating device, synthesized speech,
requiring message formulation by spelling and access
by physical contact with the device |
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E2510 |
Speech generating device, synthesized speech,
permitting multiple methods of message formulation
and multiple methods of device access |
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E2511 |
Speech generating software program, for personal
computer or personal digital assistant |
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E2512 |
Accessory for speech generating device, mounting
system |
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E2599 |
Accessory for speech generating device, not otherwise
classified |
DME Section Table of Contents 
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