Coverage Policy on Speech-Generating Devices
Medicare's Durable Medical Equipment (DME) Regional Medicare Administrative Contractors (MACs) have each adopted Local Coverage Determinations (LCDs) for speech-generating devices (SGDs). The LCDs are almost identical for all four regional MACs. The policy can be downloaded from the following MAC websites:
On this page: Summary of DMERC Policy on SGDs | Recap of HCPCS Codes for Durable Medical Equipment | FAQs | Additional Information
Summary of DMERC Policy on SGDs
Only speech-language pathologists may recommend SGD devices for Medicare beneficiaries based upon a formal written evaluation. The regional DME MAC LCD DMERCs state that speech-language pathologists "are autonomous practitioners under state law". As a result, the final SGD policy is unique among all Medicare covered items and services because it designates a non-physician (the speech-language pathologist) as the primary determiner of a beneficiary's medical need.
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-Generating Devices Information Packet.
Medicare provides benefits for all currently available digitized speech output devices (which will fall within HCPCS codes E2500 - E2506), as well as synthesized speech output devices such as the Link and Light Writer (E2508) or synthesized devices with multiple methods of message formulation and multiple methods of access, such as the Dynavox, Dynamyte, and Pathfinder (E2510). However, the final policy does not delineate specific device brands that fit within the Medicare SGD definition.
Providers may verify which brand of device is identified by Medicare within a specific HCPCS code by contacting the Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC) at 877-735-1326.
Laptop computers, desktop computers, personal digital assistants or other devices that are not dedicated SGDs are not covered because they do not meet the Medicare definition of durable medical equipment (DME). However, in early May, 2001, Medicare stated that if these devices are modified so that they are dedicated to run only AAC software, they are covered. Based on this limitation, the manufacturers of computer and PDA based devices have created "dedicated" versions of their devices, such as the Freedom 2001-E and Freestyle-II (laptop computer-based devices) and the Portable Impact-D and Portable Chat (PDA based devices). Other dedicated computer and PDA-based devices also are likely to be developed and introduced.
Speech-generating software programs that enable laptop or desktop computers to function as an SGD are covered as an SGD item under code E2511. Medicare also will cover mounts under code E2512, and AAC accessories, under code E2599.
Voice prosthetics (including voice amplifiers) are not considered SGDs and are covered under a separate Medicare benefit with a different set of procedure codes.
CPT codes 92607 - 92609 relate to the 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.
Recap of HCPCS Codes for Durable Medical Equipment
- 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 then 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
Frequently Asked Questions
Will Medicare pay for SGDs furnished to nursing home residents?
SGDs are classified by Medicare as durable medical equipment (DME). Under Medicare regulations, DME may only be furnished for use in the home or an institution defined as home. A skilled nursing facility (SNF) does not meet the Medicare definition of a home, and therefore, SGDs are not eligible for separate reimbursement for Medicare beneficiaries receiving SNF care. However, Medicare-covered services related to an SGD that are furnished by an SLP to a SNF resident are eligible for coverage.
Will Medicare pay for repairs to speech-generating devices?
Yes. Medicare regulations require coverage and payment for all repairs and replacements necessary to effectively utilize any item of DME. These claims should be submitted to the DMERCs by the supplier of the SGD.
Medicare Speech Generating Devices Information Packet
In addition, copies of Medicare's guidance, information about how to conduct a complete SGD assessment and prepare a complete report that meets Medicare's expectations, answers to frequently asked questions about Medicare, and a schedule of continuing professional education opportunities can all be found at AAC-RERC. For questions or additional information about the DMERC policy on SGDs, please contact Mark Kander, ASHA's Director of Health Care Regulatory Analysis at 301-296-5669, or via e-mail at firstname.lastname@example.org.