A speech
generating device
(E2500, E2508 -
E2511, E2502 -
E2506) is covered
when all of the
following criteria
(1-7) are met:
- Prior to
the delivery of
the SGD, the
patient has had
a formal
evaluation of
their cognitive
and
communication
abilities by a
speech-language
pathologist
(SLP). The
formal, written
evaluation must
include, at a
minimum, the
following
elements:
-
Current
communication
impairment,
including
the type,
severity,
language
skills,
cognitive
ability, and
anticipated
course of
the
impairment;
- An
assessment
of whether
the
individual's
daily
communication
needs could
be met using
other
natural
modes of
communication;
- A
description
of the
functional
communication
goals
expected to
be achieved
and
treatment
options;
-
Rationale
for
selection of
a specific
device and
any
accessories;
-
Demonstration
that the
patient
possesses a
treatment
plan that
includes a
training
schedule for
the selected
device;
- The
cognitive
and physical
abilities to
effectively
use the
selected
device and
any
accessories
to
communicate;
- 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,
- The
patient's
medical
condition is one
resulting in a
severe
expressive
speech
impairment; and,
- The
patient's
speaking needs
cannot be met
using natural
communication
methods; and,
- Other
forms of
treatment have
been considered
and ruled out;
and,
- The
patient's speech
impairment will
benefit from the
device ordered;
and,
- A copy of
the SLP's
written
evaluation and
recommendation
have been
forwarded to the
patient's
treating
physician prior
to ordering the
device; and,
- The SLP
performing the
patient
evaluation may
not be an
employee of or
have a financial
relationship
with the
supplier of the
SGD.
If one or more
of the SGD coverage
criteria 1-7 is not
met, the SGD will be
denied as not
medically necessary.
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