American Speech-Language-Hearing Association

Medicare Coverage Policy on Speech-Generating Devices

Effective January 1, 2001, Medicare recognized speech-generating devices (SGDs) as Durable Medical Equipment (DME), which is a covered benefit for Medicare beneficiaries under the Social Security Act (Section 1861).

Medicare Definition of SGD

DME is defined by Medicare as "reusable" medical equipment and is covered under Medicare Part B (outpatient) services when it is necessary for use in the home (or facility that is used as a home, such as a long-term care facility). SGDs required in inpatient facilities (skilled nursing facilities, inpatient hospitals) are the responsibility of the facility.

The National Coverage Determination (NCD) is the national Medicare policy that defines SGDs and requires the SGD to be a dedicated device used solely by the individual with the medical need. Medicare will reimburse for software that allows a computer or tablet to function as an SGD, but will not provide reimbursement for the computer or tablet.

Medicare Rules

The regional Centers for Medicare & Medicaid Services (CMS) Medicare Administrative Contractors (MACs) have issued Local Coverage Determinations (LCDs) that outline requirements for SGD reimbursement, which includes an evaluation by a speech-language pathologist (SLP). The evaluation report must be forwarded to the prescribing physician and must include current communication and cognitive abilities, daily communication needs, functional communication goals, rationale for the recommended device and accessories, and a treatment plan.

For a list of elements that must be included in the SLP's evaluation report, see Appendix A of the SLP Checklist located in the Medicare Speech-GeneratingDevices Information Packet.

The LCDs also include the requirement of the physician face-to-face visit prior to the prescription of the SGD. The face-to-face physician visit originates from the Affordable Care Act and mandates that the documentation of the visit with the physician demonstrates the beneficiary was evaluated and/or treated for a condition that supports the need for the SGD. A dispensing order is not sufficient documentation; a Written Order Prior to Delivery (WOPD) is required and must be forwarded to the supplier prior to the delivery of the SGD. In the case of an audit, the supplier is responsible for the WOPD.

Medicare will only reimburse a Medicare-enrolled DME provider that has met the requirements in the Medicare Program Integrity Manual.

Voice prosthetics (including voice amplifiers, HCPCS L8500-L8515) are not considered SGDs and are covered under a separate Medicare benefit with a different set of procedure codes.

Capped Rental

Effective April 1, 2014, CMS classified SGDs as capped rental items under the Medicare benefit. The capped rental classification requires a rental period prior to purchase. After 13 monthly rental payments under the Part B, outpatient services benefit from Medicare to the supplier, the title for the equipment will transfer to the beneficiary.

For coverage under Part A, the extended care benefit provides comprehensive coverage, including any medically necessary durable medical equipment (DME). If a Medicare beneficiary has a medical need for DME during the course of the Part A stay, the inpatient facility is obligated to furnish it. Prior to April 1, 2014, Medicare beneficiaries who owned the equipment may have furnished their own SGD, instead of depending on the extended care benefit. This is still an option for beneficiaries who take over ownership of the equipment after 13 months of continuous Part B rental payments. However, if the beneficiary enters an inpatient facility under a covered Part A stay and is in the middle of the 13-month capped rental period under Part B for the item, it is the responsibility of the inpatient facility to ensure that the beneficiary has access to this equipment that is medically necessary. The next monthly rental payment to the supplier cannot be made by Medicare until the patient is discharged from the inpatient stay. The supplier may enter an agreement for the facility to continue payment during the stay, or the patient can furnish his/her own device.

Payment to the supplier for the capped rental item occurs monthly beginning on the date of service that the device was delivered and continuing monthly on that date. Payment for all maintenance, servicing, and repair of capped rental DME is included in the allowed rental payment amounts. The device may be delivered to the Medicare beneficiary 2 days prior to the date of discharge from an inpatient stay, if it is the intent that the device will be used at home. In this case, the date of service is the beneficiary's first day home.

In the case where a beneficiary enters an inpatient facility and the stay occurs beyond the end of the rental month, a new date of service will be established when the beneficiary returns home and that time will not be applied toward the 13-month total. A break in service is defined by CMS as 60 consecutive days plus the days remaining in the rental month. If a break in service occurs, a new physician prescription and new Certificate of Medical Necessity are required, and a new 13-month rental period begins. The physician prescription requires a written evaluation by the speech-language pathologist.

If equipment is changed because the beneficiary's condition has substantially changed to support the medical necessity for the new item, a new 13-month period will begin. The new item must use a different HCPCS code (see below). If the same HCPCS is involved, a change in medical necessity is not supported and the rental will continue to count against the current 13-month period. If the 13-month period has already expired, no additional rental payment will be made for modified or substituted equipment, unless there was a significant change in medical need.

Billing Codes

CPT codes 92607-92609 relate to speech-language pathology services for SGDs. CPT 92607 is used for coding the first hour of the evaluation for an SGD prescription. CPT 92608 allows the SLP to bill for each additional 30 minutes. Therapeutic services for the use of an SGD are reported using 92609.

The device codes are:

  • 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 specified

see also: Additional speech-language pathology related HCPCS codes

Additional Resources

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