Effective Date:

a)    This policy will apply to all services performed on or after the above revision date which will become the new effective date.

b)    For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply.

When a Speech Generating Device is covered under a QualChoice plan, both the device and the evaluation and services related to the device require preauthorization.

Speech Generating Devices are electronic devices which produce synthesized or prerecorded speech or other forms of verbal (perhaps written rather than spoken) communication in response to input from the patient. Vibrators and other noise producers designed to substitute for vocal cords in allowing a laryngectomized individual to articulate speech are not considered in this category, and are covered as DME. Speech Generating Devices are not covered under most QualChoice plans.  Refer to your Summary Plan Description, Certificate of Coverage, or Explanation of Coverage.

QualChoice may not cover speech generation devices. For plans where these devices

are covered, preauthorization of both the device and services related to the device are

required.  The following medical necessity criteria apply and the member should meet

ALL of the following criteria:

1. Prior to the delivery of the Speech Generating Device (SGD), the patient has had a formal evaluation of their cognitive and language abilities by a speech-language pathologist (SLP). The formal, written evaluation must include, at a minimum, ALL of the following elements:

a.     Evaluation of current communication impairment, including the type, severity, language skills, cognitive ability, and anticipated course of the impairment;

b.     An assessment of whether the individual`s daily communication needs could be met using natural modes of communication;

c.     A description of the functional communication goals expected to be achieved and treatment options;

d.     Rationale for selection of a specific device and accessories;

e.     A treatment plan that includes a training schedule for the selected device;

f.      Demonstration that the patient possesses the cognitive and physical abilities to effectively use the selected device and any accessories to communicate;

g.     For a subsequent upgrade to a previously issued SGD, information regarding the functional benefit to the patient of the upgrade compared to the initially provided SGD; AND

1. The patient`s medical condition is one resulting in a permanent severe expressive speech disability; 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 disability will benefit from the device ordered; and
5. A copy of the Speech and Language Pathologist`s (SLP) 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 may not be an employee or have a financial relationship with the supplier of the SGD.

Codes Used In This BI:

1.          Laptop computers, desktop computers, personal digital assistants (PDAs), or other devices that are not dedicated SGDs are not covered because they do not meet the definition of durable medical equipment.

2.          Communication aids that do not generate speech are not covered. Communication aids that are not SGDs are not considered prosthetics for speech, as they do not replace internal or external body parts lost or impaired by disease or injury. Examples of non-covered communication aids include the following: picture books; flashcards; Braille typewriters; TTY (text telephone or TDD) devices; devices that allow the patient to communicate messages to others with writing (e.g., a display screen or printout) rather than with synthesized speech; and devices that allow the user to communicate with a computer rather than with another person. Although communication aids that do not generate (synthesize) speech may be useful to patients who otherwise cannot communicate, they do not meet the definition of a prosthetic device under QualChoice plans.

3.          Any software, interfaces, cables, adapters, interconnects, and switches necessary for an accessory to interface with the Speech Generating Device are not covered.

1. Poole CJ, Millman A. ABC of medical computing. Adaptive computer technology. Br Med J. 1995; 311(7013):1149-1151.
2. Pehringer JL. Assistive devices: technology to improve communication. Otolaryngol Clin North Am. 1989; 22(1):143-174.
3. Redford JB. Assistive devices. In: Practice of Geriatrics. 3rd Ed. EH Duthie, JR Katz, eds. Philadelphia, PA: W.B. Saunders Co.; 1998; 173-186.
4. Rostron A, Ward S, Plant R. Computerized augmentative communication devices for people with dysphasia: design and evaluation. Eur J Discord Commun. 1996; 31(1):11-30.
5. Beukelman DR, Mirenda P. Augmentative and alternative communication: management of severe communication disorders in children and adults. Baltimore, MD: P.H. Brookes Publishers.; 1998.
6. Lloyd LL, Fuller DR, Arvidson HH. Augmentative and alternative communication: a handbook of principles and practices. Boston, MA: Allyn and Bacon; 1997.
7. Cigna/Medicare coverage: http://www.cignamedicare.com/pdf/dmerc/supman/chapter09/sm09_SGD.pdf accessed June 15/2004

Addendum:

Effective 12/01/2017: Clarification added regarding preauthorization of both device and related services