Coverage Reminder - Speech Generating Devices - Revised
Joint DME MAC Publication
The following bulletin article, published by the DME MACs in February, 2014 is being revised to update the Coding Verification Review (CVR) information. The remainder of the article is unchanged.
The Centers for Medicare & Medicaid Services (CMS) National Coverage Determination for Speech Generating Devices (IOM 100-3 §50.1), specifies that in order for a speech generating device (SGD) to be considered for reimbursement under the Durable Medical Equipment (DME) benefit, it must be a "dedicated" device. Dedicated device means that the SGD must be a device limited solely to the generation of speech, for use only by the individual who has a severe speech impairment. The NCD states:
Devices that would not meet the definition of speech generating devices and therefore, do not fall within the scope of §1861(n) of the Act are characterized by:
- Devices that are not dedicated speech devices, but are devices that are capable of running software for purposes other than for speech generation, e.g., devices that can also run a word processing package, an accounting program, or perform other than non-medical function.
- Laptop computers, desktop computers, or PDA's which may be programmed to perform the same function as a speech-generating device, are noncovered since they are not primarily medical in nature and do not meet the definition of DME. For this reason, they cannot be considered speech- generating devices for Medicare coverage purposes.
- A device that is useful to someone without severe speech impairment is not considered a speech-generating device for Medicare coverage purposes.
This benefit does not extend coverage to the broader range of augmentative and alternative communications devices (AAC) that have capabilities exceeding the sole function(s) of speech generation such as (not all-inclusive): wireless and cellular communication capabilities, environmental control capability, non-speech generating software (e.g., games, word processing, email).
Products provided as a dedicated device that have the capability to be expanded with additional hardware and/or software or where additional functionality may be made available by "unlocking" hardware or software limitations do not meet the NCD requirement for classification as a dedicated device. Such non-dedicated devices are not eligible for coverage and should be coded A9270 (Noncovered item or service).
For the purposes of Medicare reimbursement, the term SGD also describes Speech Generating Device software/programs installed for use on a personal computer or other device. While the software/program is a covered benefit when all other coverage criteria in the SGD Local Coverage Determination (LCD) and related Policy Article (PA) are met, the device that runs the SGD software (e.g. laptop computer, tablet, smartphone) is not a covered item as it is not primarily medical in nature and does not meet the definition of DME. The installation and technical support of the program on a non-dedicated device is not separately reimbursable. Finally, technical support or repairs (if necessary) is non-covered for the non-dedicated device hosting the SGD software.
Suppliers are reminded that accessories/peripherals (e.g. (not all-inclusive), keyboards, mice, pointing devices, ocular tracking systems) for use with an SGD are eligible for reimbursement only after a determination has been made that the accessory/peripheral is essential for the effective use of a dedicated SGD as described above and all other coverage criteria in the SGD Local Coverage Determination (LCD) and related Policy Article (PA) are met. In addition, accessories/peripherals for use on a non-dedicated device running SGD software are non-covered.
Suppliers should read the entire LCD and related Policy Article for additional coverage, coding and documentation requirements.
Effective for claims with dates of service on or after December 1, 2014, the only products which may be billed to Medicare for SGDs are those for which a written coding verification has been made by the PDAC contractor and that are listed in the Product Classification List in DMECS maintained on the PDAC website, https://www.dmepdac.com/dmecsapp/. A written coding verification is not needed in order to submit claims to Medicare for SGDs furnished prior to December 1, 2014.
The PDAC coding verification application required for these products is the DME and Supplies Application. This application is located on the PDAC website, https://www.dmepdac.com/review/apps_check.html.
For questions about correct coding, contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC website: https://www.dmepdac.com/.
Last Updated Jan 03, 2018