CurrentMass General Brigham Health PlanPolicy 053

Speech Generating Devices

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This policy governs medical-necessity determinations and prior-authorization requirements for speech-generating devices, augmentative and alternative communication devices, and associated software for members with severe expressive communication impairments.

Policy Summary

PayerMass General Brigham Health Plan

PolicySpeech Generating Devices

Policy CodePolicy 053

Change TypeRevised

Effective DateOctober 1, 2026

Last ReviewOct 1, 2026

Next Review DateN/A

Key ActionObtain prior authorization for speech-generating devices before submitting requests for Medicare Advantage members.

SourceLink

POLICY UPDATE CHANGES

The October 1, 2026 ad hoc review updated the Mass General Brigham ACO section.

The January 2026 ad hoc review added a prior-authorization variation for One Care and Senior Care Options members and information on the customized InterQual subset.

The September 2025 annual review updated criteria to reflect use of InterQual and resumed the prior-authorization requirement.

3 yearsMinimum replacement and upgrade interval

12Explicit exclusion categories

Least intensive

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CurrentMass General Brigham Health PlanPolicy 053

Speech Generating Devices

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Policy Summary

PayerMass General Brigham Health Plan

PolicySpeech Generating Devices

Policy CodePolicy 053

Change TypeRevised

Effective DateOctober 1, 2026

Last ReviewOct 1, 2026

Next Review DateN/A

Key ActionObtain prior authorization for speech-generating devices before submitting requests for Medicare Advantage members.

SourceLink

POLICY UPDATE CHANGES

The October 1, 2026 ad hoc review updated the Mass General Brigham ACO section.

The January 2026 ad hoc review added a prior-authorization variation for One Care and Senior Care Options members and information on the customized InterQual subset.

The September 2025 annual review updated criteria to reflect use of InterQual and resumed the prior-authorization requirement.

3 yearsMinimum replacement and upgrade interval

12Explicit exclusion categories

Least intensive

Line of Business Coverage Criteria

Medicare Advantage criteria

Medicare Advantage members are evaluated using CMS guidance; when CMS has no applicable guidance, the plan's medical policies are used.

CMS medical-necessity pathway: Apply the applicable National Coverage Determination (NCD), Local Coverage Determination (LCD), Local Coverage Article (LCA), and documentation in the Medicare manuals for speech-generating devices.

If CMS provides no guidance for the requested service, use Mass General Brigham Health Plan medical policies.

Mass General Brigham ACO criteria

Mass General Brigham ACO members are evaluated using MassHealth guidance, with a Medicare or commercial fallback pathway when applicable.

ACO medical-necessity pathway: Use MassHealth guidance for the requested durable medical equipment; if MassHealth has no applicable guidance, refer to the Medicare variation for the relevant LCD; if no relevant LCD exists, use the Commercial and Qualified Health Plans section.

One Care and SCO criteria

One Care and Senior Care Options members are evaluated using CMS guidance and, when applicable, MassHealth criteria.

One Care and SCO medical-necessity pathway: Use CMS NCDs, LCDs, LCAs, and documentation in the Medicare manuals; when CMS guidance is unavailable or the member does not meet all Medicare medical-necessity criteria, apply MassHealth medical-necessity guidelines.

Medicare Advantage criteria and exclusions apply before the MassHealth fallback.

Commercial and Qualified Health Plan criteria

Commercial and Qualified Health Plan medical necessity is determined through customized InterQual criteria.

Customized InterQual criteria: Apply the customized InterQual criteria for speech-generating devices accessed through the Mass General Brigham Health Plan provider website.

The criteria are customized to include the exclusions stated in this policy.

Coverage is excluded when the requirements for coverage have not been met.

Coverage is excluded when the member fails, during the training schedule or at any subsequent time, to demonstrate the ability to learn to use the device or software functionally for communication.

Coverage is excluded when the member demonstrates significant behaviors during the training schedule, such as physical aggression or property destruction.

Replacement is excluded when the device was damaged or lost due to neglect.

Replacement requests made less than three years from receipt of the initial device are excluded unless documentation supports irreparable damage that was not caused by property destruction or neglect by the member.

Upgrade requests made less than three years from receipt of the initial device are excluded.

An upgrade is excluded when the request does not clearly identify the functional benefit the upgrade would provide over the existing device.

Coverage is excluded for duplicate devices or software, including accessories used for mounting.

Coverage excludes charges for web, cellular, or other device connectivity, as well as home modifications and technical support.

Coverage excludes voice amplifiers for members whose speech-volume or intelligibility problems are due to vocal strain.

Tracheoesophageal voice prostheses are excluded from coverage.

Coverage excludes altered auditory feedback devices used to treat stuttering.

Authorized Codes

Authorized CodeHCPCS

E2512	Accessory for speech generating device, mounting system.
E2599	Accessory for speech generating device, not otherwise classified.

Authorization and Provider Requirements

Prior Authorization

Medicare Advantage Prior Authorization Required

Prior authorization is required for speech generating devices for Mass General Brigham Health Plan Medicare Advantage members. Apply CMS coverage and documentation sources first; when CMS provides no guidance, use the Health Plan’s medical policies.

CMS NCD: Speech Generating Devices (50.1)
CMS LCD: Speech Generating Devices (SGD) (L33739)
CMS Article: Speech Generating Devices (SGD) - Policy Article (A52469)

Prior Authorization

ACO Prior Authorization Required

Prior authorization is required for speech generating devices for Mass General Brigham ACO members. Use MassHealth guidance first; if MassHealth has no guidance for the specific DME, use the Medicare Variation for the relevant LCD, and if no relevant LCD exists, use the Commercial and Qualified Health Plans section.

Policy Background

Speech-generating devices are durable medical equipment for individuals with severe speech impairment who need support meeting functional speaking and communication needs. These devices may generate speech directly or use software that enables a computer, tablet, or personal digital assistant to function as a speech-generating device.

Key Definitions

Speech Generating Device (SGD)

Defined termSpeech Generating Device (SGD)

Equipment typeDurable medical equipment that provides an individual with severe speech impairment the ability to meet functional speaking needs.

How it worksA speech aid consisting of a device or software that generates speech and is used solely by the individual with severe speech impairment.

Speech Generating Software

Defined termSpeech Generating Software

FunctionEnables a desktop or laptop computer, tablet, or personal digital assistant (PDA) to function as a speech-generating device.

General Medical-Necessity Criteria

General speech-generating device criteria

Covered when the requested equipment or software is medically necessary for a member with severe expressive communication impairment and represents the least intensive level of services.

General SGD medical-necessity framework: The requested speech-generating device, augmentative and alternative communication device, accessory, or associated software must be medically necessary for a member with severe expressive communication impairment.

Service intensity: The requested device, accessory, or software must represent the least intensive level of services.

Replacement and Upgrade Intervals

Speech-generating device replacement interval

EquipmentSpeech-generating devices

Minimum intervalAt least 3 years

Interval beginsFrom receipt of the initial device

Replacement and upgrade interval

Replacement intervalAt least 3 years from receipt of the initial device.

Early replacement exceptionAn earlier replacement may be considered only when documentation supports irreparable damage that is not a result of property destruction or neglect by the member.

Upgrade requirement

Required Supporting Documentation

Documentation Required

Document the basis for an early replacement

For a replacement requested less than three years from receipt of the initial device, submit documentation supporting irreparable damage. The documentation must establish that the damage was not caused by property destruction or member neglect.

Document irreparable damage.
Document that the damage was not caused by property destruction.
Document that the damage was not caused by member neglect.

Documentation Required

Document functional use of the requested device

Document the member’s ability to learn and use the requested device or software functionally for communication during the training schedule or at any subsequent time.

Ability to learn functional use during training
Functional communication use during training or subsequently

Excluded Services and Items

The least intensive level of services must be used for covered speech-generating devices, accessories, and software. Coverage does not include devices, accessories, or software that are not the least intensive level of services; duplicate devices or software, including mounting accessories; connectivity charges, home modifications, or technical support; voice amplifiers for vocal-strain-related speech-volume or intelligibility problems; tracheoesophageal voice prostheses; or altered auditory feedback devices for stuttering.