Speech generating devices (SGDs) are speech aids that provide individuals with severe speech impairment the ability to meet their functional speaking needs. SGDs provide digitized speech as well as synthesized speech. However, SGDs do not include external speech processors that are part of a cochlear device/system used to capture and amplify sound.
This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.
Coverage is subject to the specific terms of the member's benefit plan.
SGDs may be considered medically necessary when ordered by the treating physician and ALL of the following criteria are met:
Accessories may be considered medically necessary if the coverage criteria for the base device are met and the medical necessity for each accessory is clearly documented in the formal written evaluation by the SLP. Speech pathology services pertaining to the individual's evaluation and training in use of these devices may also be considered medically necessary.
If all the SGD coverage criteria are not met, the SGD will be denied as not medically necessary. When the SGD is not covered, accessories are also not covered.
Requests for more than one SGD will be denied as not medically necessary.
Laptop computers, desktop computers, personal digital assistant s (PDAs) or other devices that are not dedicated SGDs are not covered because they do not meet the definition of durable medical equipment (DME). This is a benefit denial.
Communication aids that are not speech generating devices (e.g., communication boards) do not meet the definition of DME. Therefore, they are benefit denials. In addition, services related to non-speech generating devices are also not covered.
The SGD and its components may not be billed separately.
Speech generating software programs enabling a laptop computer, desktop computer or PDA to function as an SGD may be considered medically necessary as a SGD within the terms of this policy. Installation of the program or technical support is not separately reimbursable.
Separate billing should not be made for any software, interfaces, cables, adapters, interconnects, or switches necessary for the accessory to interface with the SGD.
Eye gaze or eye glance technology (e.g., DynaVox EyeMax System) may be considered medically necessary for an individual who meets the requirements for a SGD as documented on this policy, but has limited use of his or her extremities that renders the individual unable to control or sustain fine/gross body movements that would enable him or her to access an SGD using more conventional access methods such as switches or direct touch. The individual must have direct vision in one or both eyes, and for full control over the system, should have the ability to look up, down, left and right. The individual must also have adequate vision to view the screen, and must have the ability to focus on one spot for a brief period of time. Contraindications include, but may not be limited to, those individuals with the following conditions: continuous, uncontrolled head movement; nystagmus. It will be necessary for the provider to submit medical records and/or additional documentation to determine coverage for eye gaze access devices.