Speech Generating Devices
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Covers medical necessity criteria, documentation, coding guidance, and coverage stance for electronic speech generating devices and related accessories for members with severe expressive speech impairment.
Policy titled 'Speech Generating Devices' was reinstated on 5/1/24 and BCBSNC will provide coverage when medical criteria are met.
HCPCS code E2513 was added to the Billing/Coding section, effective 10/1/24.
Coverage criteria for Speech Generating Devices
When Speech Generating Devices are Covered
Covered when ALL of the following are met
All criteria required for coverage
Devices or software that are not dedicated to speech generation are excluded from coverage. This includes general-purpose hardware such as laptop or desktop computers, smart phones, and tablet PCs, as well as non-dedicated applications and routine software installation. Such items are not considered Durable Medical Equipment (DME) or Speech Generating Devices because they can be useful to individuals without severe speech impairment and therefore are not primarily medical in nature.
A device or software application is not medically necessary if the policy’s required coverage criteria are not all met. Specifically, devices are considered not medically necessary when the formal speech-language pathologist (SLP) evaluation with its required elements and the signed physician recommendation are not provided, when the individual does not have a medical condition resulting in a severe expressive speech impairment, when the individual’s needs can be met with natural communication methods, or when other required conditions in the coverage criteria are unmet. Additionally, any device or software that is not primarily and customarily used to serve a medical purpose (for example, general-purpose computers or non-dedicated apps) is regarded as not medically necessary.
Applicable service codes and coding guidance
| E2500 | Applicable service code (speech generating device-related) |
| E2502 | Applicable service code (speech generating device-related) |
| E2504 | Applicable service code (speech generating device-related) |
| E2506 | Applicable service code (speech generating device-related) |
| E2508 | Applicable service code (speech generating device-related) |
| E2510 | Applicable service code (speech generating device-related) |
| E2511 | Applicable service code (speech generating device-related) |
| E2512 | Applicable service code (speech generating device-related) |
| E2513 | Applicable service code (added effective 10/1/24) |
| E2599 | Applicable service code (speech generating device-related) |
Provider actions — authorization, documentation, and treatment alternatives
Prior authorization / submit SLP evaluation and physician signature before delivery
Prior to delivery, submit the formal, written speech‑language pathologist (SLP) evaluation and the treating physician’s signature for review to establish medical necessity; DME suppliers must meet plan eligibility/credentialing requirements to be reimbursed.
- Submit the SLP’s written evaluation and recommendation signed by the treating physician prior to device delivery for medical necessity review.
- Ensure the SLP who performed the evaluation has no employment or financial relationship with the device supplier.
- Suppliers must meet plan eligibility/credentialing requirements for reimbursement.
Consider and rule out alternative treatments and natural communication methods
Other forms of treatment must be considered and ruled out before coverage of a speech generating device is allowed; the SLP evaluation must document that natural communication methods and alternative treatments have been assessed and found insufficient.
- Document assessment of whether the individual’s daily communication needs could be met using other natural modes of communication.
- Confirm and document that other forms of treatment have been considered and ruled out.
Required documentation: formal SLP evaluation with seven specified elements and physician signature
Provide a formal, written evaluation by a speech‑language pathologist that is signed by the treating physician and includes all required elements listed below; this documentation must be submitted prior to delivery for medical necessity review.
- Current communication impairment: type, severity, language skills, cognitive ability, and anticipated course of the impairment.
- Assessment of whether daily communication needs could be met using other natural modes of communication.
- Description of functional communication goals expected and treatment options.
- Rationale for selection of the specific device and any accessories.
- Demonstration of 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 subsequent upgrades, information regarding the functional benefit of the upgrade compared to the initially provided device.
Triggers for denial: missing documentation, unmet criteria, or non‑dedicated devices
Claims may be denied if the formal SLP evaluation or any of the required elements are missing, if medical necessity criteria are not met (e.g., no severe expressive speech impairment or speaking needs could be met naturally), or if the device/software is not primarily and customarily used to serve a medical purpose.
- Missing SLP evaluation or missing one or more of the seven required elements.
- The individual does not have a medical condition resulting in a severe expressive speech impairment.
- The individual’s speaking needs can be met using natural communication methods.
- Failure to provide the SLP evaluation signed by the treating physician.
- Device or software is not primarily dedicated to speech generation (e.g., general laptops, smartphones, tablets, or non-dedicated apps).
DME medical necessity requirements for SGDs
DME medical necessity for SGDs
All items required
Treatment of devices as DME, supplier and reimbursement rules
| Topic | Policy statement / rule |
|---|---|
| Policy classification | |
| Speech generating devices and augmentative communication equipment are treated as durable medical equipment (DME). | |
| Supplier eligibility/credentialing | |
| DME suppliers must meet eligibility and/or credentialing requirements defined by the Plan to be eligible for reimbursement. | |
| Purchase vs rental | |
| The policy text does not specify explicit rental versus purchase rules; devices are treated as DME and standard DME billing guidance applies. | |
| Accessories and upgrades | |
| Accessories may be considered medically necessary if criteria for the base device are met and medical necessity for each accessory is clearly documented in the formal SLP evaluation. For upgrades, information regarding functional benefit compared to the initially provided device must be submitted to demonstrate medical necessity. | |
| Quantity/limits | |
| Only one device or software application at a time is considered medically necessary per member. |
Device upgrades and accessories
Submission timing and required supporting documents
Submit evaluation, physician signature, training schedule, and rationale prior to delivery
Before delivery, submit for medical necessity review: the formal SLP evaluation (with required elements), the treating physician’s signed copy of the evaluation, the device training schedule, and the clinical rationale for the device and any accessories.
Background on Speech Generating Devices
Speech Generating Devices (SGDs) are electronic or computer-based systems that produce synthesized and/or digitized audible speech output for individuals with severe expressive speech impairment. They are intended to establish, develop, or maintain functional communication by enabling multiple message formulation and access methods. Coverage is intended for members whose speaking needs cannot be met through natural communication modes (such as speech, writing, or sign language) and who will demonstrably benefit from the device when evaluated and documented by a qualified speech-language pathologist.
Definitions and non-covered device examples
Not covered items
The policy explicitly excludes coverage for non-dedicated consumer devices and non-medical software or hardware accessories. Examples of NOT COVERED items include laptop or desktop computers, smart phones, tablet PCs, non-dedicated applications, routine software installation, and hardware/software accessories that are not primarily medical in nature. Accessories may only be considered medically necessary if the base device meets criteria and the formal SLP evaluation clearly documents the medical need for each accessory.
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