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Coverage criteria policies

Augmentative communication device – Minnesota Health Care Programs

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Augmentative communication devices (ACD) and Electronic speech aids (ESA) do not require prior authorization.

Coverage

An augmentative communication device (ACD) or an electronic speech aid (ESA) is generally covered according to the indications below, and per your plan documents.

Indications that are covered

An electronic speech aid is covered without prior authorization for members with a diagnosis of post-laryngectomy, or when the larynx is permanently non-functional, such as post radical neck surgery or radiation. Examples of covered devices for these conditions are an artificial larynx (L8500), a tracheostomy-speaking valve (L8501) or a voice amplifier (L8510).

An augmentative communication (ACD) or speech-generating device dedicated to transmitting or producing messages or symbols in a manner that compensates for the impairment and disability of a member with severe expressive communication disorders and limitations is generally covered.

  1. To be covered as a rehabilitative and therapeutic service, the recipient’s physician must prescribe an AC device. The speech-language pathologist must specify the device in a plan of care (POC) that is reviewed and revised as medically necessary by the recipient’s physician, or other licensed practitioner of the healing arts.
  2. Examples of covered ACDs include, but are not limited to: communication picture books, communication charts and boards, other mechanical/electronic dedicated devices and tablets, including, but not limited to an Apple iPad and communication software application.
  3. Accessories may include, but are not limited to: a carrying case, a mounting system and hardware, a protective case for non-dedicated tablets, and other accessories determined to be medically necessary.
  4. Other covered services include those necessary to set up and maintain the device, including registering the device, downloading software, and updating the software application.
  5. MHCP covers electronic tablets when they are to be used as augmentative communication (AC) devices. A tablet used for this purpose is considered durable medical equipment (DME) and must be dedicated for a recipient’s communication needs. Electronic tablets used as AC devices must meet the same coverage criteria as other devices. In addition, they must meet the following:
    1. The recipient’s speech language pathologist (SLP) must determine the tablet and software application that is the most appropriate, cost-effective choice for a recipient’s communication needs
    2. The tablet must be locked to prevent use not related to communication. Locking features include Parental Controls and Guided Access (for iPad®) or other comparable feature for other tablets
  6. The vendor must have the following information on file:
    1. A description of the member's current medical status and history.
    2. An assessment of verbal and physical capabilities in relation to the need and use of an ACD (electronic and non-electronic).
    3. A detailed description of the therapeutic history (physical therapy, occupational therapy, and speech-language pathology), including nature, frequency and duration of therapeutic services provided.
    4. Details of the speech-language pathology approaches in relation to the need and use of an ACD.
    5. A trial period of the device is required when there is no device currently being used
    6. An explicit evaluation of each ACD or method of communication tried by the member, and information on the effectiveness of each device. All parameters of device selection must be addressed (i.e., interactive ability in all situational contexts; school, home, community, vocational, work, and social environments).
    7. A detailed description of the member's ability to use the proposed device, including speed and accuracy.
    8. Situation references dependent upon the mobility level of the member must be addressed (e.g., How will the device be adapted to meet the needs of someone who uses a walker? Is the communication device less obtrusive than other methods when mobility levels are considered?).
    9. Empirical data regarding the trial period of use with the device is required (e.g., frequency of device use in various settings).
    10. A description of the level of communication initiation with the selected device and whether or not the equipment is used accurately and spontaneously. If the pattern of initiation is different from past history, provide an explanation and justification for the change.
    11. A detailed description and plan for the proposed nature, frequency, and duration of therapeutic intervention, including all necessary therapeutic interventions, in relation to the AC device.
  7. Technical services for repairs of covered items.

Indications that are not covered

  1. Augmentative Communication/Speech-Generating devices requested for the sole purpose of education
  2. Environmental control devices such as switches, control boxes or battery interrupters
  3. Modification, construction, programming, or adaptation of dedicated communication systems or devices
  4. Repairs, cleaning or other services for devices that are not dedicated communication devices
  5. Upgrading to new technology that is not proven to be medically necessary
  6. Replacing devices based on manufacturer’s recommended replacement schedule; i.e., every 5 years
  7. Facilitated communication: a technique by which a "facilitator" provides physical and other supports in an attempt to assist a person with a significant communication disability to point to pictures, objects, and printed words or letters. This is not covered when received form any type of provider.
  8. Personal computers, laptop computers and other personal media players that are not dedicated communication devices
  9. Portable, electronic devices that are not designated to have a primary use as AC devices
  10. Telephones, smartphones or cell phones
  11. Carrying cases when a mounting system (E2512) has been provided
  12. Applications, software or programs that have not been recommended by the speech-language pathologist or are not designated to have primary use as a communication tool
  13. More than one speech-generating device
  14. Extended warranties
  15. Wi-Fi/ Internet service

Definitions

Augmentative Communication Devices (ACD) are devices dedicated to transmitting or producing messages or symbols in a manner that compensates for the impairment and disability of a member with severe expressive communication disorders and limitations.

Dedicated AC Devices and Tablets – For the purpose of this policy, dedicated ACDs and tablets are those designed, trademarked and supplied by the individual manufacturer.

Electronic speech aid - a prosthetic device used by persons who have undergone laryngectomy or persons with a permanently non-functional larynx. One type operates by placing a vibrating head against the throat. Another amplifies sound waves through a tube which is inserted into the user's mouth.

Electronic Tablet is a mobile computer with display, circuitry and battery in a single unit.

Examples include the Apple iPad® or Samsung Galaxy®. These tablets are not designed specifically to be used as AC devices and require added communication software for AC use. To be covered, the tablet must be locked to prevent use not related to augmentative communication.

Facilitated communication is a technique by which a "facilitator" provides physical and other supports in an attempt to assist a person with a significant communication disability to point to pictures, objects, printed letters or words.

Non-dedicated Tablet – For the purpose of this policy, this refers to any electronic tablet designed for multipurpose use and sold (provided) by manufacturers, retailers and suppliers. Examples of these tablets include Apple iPad® or Samsung Galaxy®. To be covered under MHCP, these tablets must be locked to prevent use other than communication. Once locked, these tablets would be considered “dedicated”, and eligible for coverage.

Practitioner of the Healing Arts includes any person who engages in, or holds out to the public as being engaged in, the practice of medicine or surgery, the practice of osteopathy, or other practitioner of the healing arts whose scope of practice under state law includes diagnosis of disease or health condition and prescribing treatment; for example, physician assistant, nurse practitioner, podiatrist, oral surgeon, dentist, optometrist.

Traditional Tablets are tablets specifically for use as speech-generating devices; these are referred to as “traditional” tablets. Traditional tablets are designed to be used as ACDs and come with their own software.

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

Electronic Speech Aids

Codes

Description

L8500

Artificial larynx, any type

L8501

Tracheostomy-speaking valve

L8510

Voice Amplifier

Dedicated AC Devices from a manufacturer

Codes

Description

E2500

Speech generating device, digitized speech, using pre-recorded messages, less than or equal to eight minutes recording time

E2502

Speech generating device, digitized speech, using prerecorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time

E2504

Speech generating device, digitized speech, using prerecorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time

E2506

Speech generating device, digitized speech, using prerecorded 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

E2512

Accessory for speech generating device, mounting system

E2599

Accessory for speech generating device, not otherwise classified

Electronic Tablets as AC Devices from a DME Supplier

Codes

Description

E2510

Speech generating device, including electronic tablets, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access

E2511

Software applications for electronic tablets

E2512

Accessory for speech generating device, mounting system

E2599

Accessory for speech generating device, not otherwise classified

K0739

Repair or non-routine service for durable medical equipment per 15 minutes. For tablets - includes technical support by supplier

Modifier U3 is required for all tablets, tablet accessories and related services.

CPT Copyright American Medical Association. All rights reserved.  CPT is a registered trademark of the American Medical Association.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy contact Member Services at 952-883-7979 or 1-800-233-9645.

Portions of this policy were taken from the MHCP website: http://www.dhs.state.mn.us/main/idcplg?IdcService=
GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_156515

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Policy activity

  • 04/01/1998 - Date of origin
  • 04/01/2017 - Effective date
Review date
  • 04/2017

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