CurrentMass General Brigham Health PlanPolicy N/A

Speech Generating Devices (Augmentative and Alternative Communication Devices)

Defines Mass General Brigham Health Plan's medical necessity, coverage criteria, and authorization requirements for speech generating devices and associated software for members with severe expressive communication impairments.

Policy Summary

PayerMass General Brigham Health Plan

PolicySpeech Generating Devices (Augmentative and Alternative Communication Devices)

Policy CodePolicy N/A

Change TypeAdded NCDresumed prior authorizationMassHealth variation added

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization where required and document InterQual-based medical necessity, training, and functional ability to use the device.

SourceLink

POLICY UPDATE CHANGES

Added NCD. Resumed PA requirement.

Added MassHealth Variation.

Medicare Advantage added to coverage table and Medicare variation language updated.

InterQualClinical criteria source

10HCPCS codes listed

NCD/LCDMedicare guidance referenced

12Explicit exclusions

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Coverage and Medical Necessity Criteria

Medical Necessity (InterQual-based)

Covered when InterQual criteria for speech generating devices are met and the device/software is the least intensive option addressing the member's severe expressive communication impairment.

InterQual-based medical necessity: Medical necessity for speech generating devices is determined through InterQual criteria; provider must reference InterQual documentation for specific clinical criteria.

Access InterQual via Mass General Brigham Health Plan provider website (InterQual Criteria Lookup under Resources).

Coverage is excluded when any of the policy requirements are not met. Specific exclusions include: inability to meet coverage requirements; failure to demonstrate during the training schedule or at any subsequent time the ability to learn to use the device or software functionally for communication; significant behaviors during training such as physical aggression or property destruction; replacements for devices damaged or lost due to neglect; duplicate devices or software (including mounting accessories); charges for web, cellular, or other device connectivity, home modifications, and technical support; voice amplifiers for members whose speech issues are related to vocal strain; tracheoesophageal voice prostheses; and altered auditory feedback devices for treatment of stuttering.

Requests for replacement or upgrade of a speech generating device received less than three years from the date the member received the initial device are considered not medically necessary, unless documentation demonstrates irreparable damage that is not the result of property destruction or neglect. Upgrade requests submitted within three years must also identify clear functional benefit over the existing device to be considered medically necessary.

HCPCS and Related Codes

Listed HCPCS Codes (informational)HCPCS

E1399	iPads and tablets configured as speech generating devices (MassHealth members only).
E2500	Speech generating device, digitized speech, using prerecorded.
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.
E2511	Speech generating software program, for personal computer or personal digital assistant.
E2512	Accessory for speech generating device—mounting system.
E2599	Accessory for speech generating device, not otherwise classified.

Prior Authorization, Documentation, and Denial Triggers

Prior Authorization

Prior authorization required for specified lines of business

Authorization is required for Commercial, Connector/Qualified Health Plans, MassHealth, and Medicare Advantage members. Prior authorization requirements were modified in the policy history (see Effective section).

Step Therapy

Least-intensive alternative required

The plan will not compensate for devices, accessories, or software programs that are not the least intensive level of services; providers must select the least intensive device/software that addresses the member's needs.

Documentation Required

Document InterQual-based medical necessity and functional use

Medical necessity determinations rely on InterQual criteria; documentation must support severe expressive communication impairment, functional speaking needs, and evidence from training that the member can use the SGD or software functionally.

Reference InterQual criteria via the plan provider website (InterQual Criteria Lookup).
Clinical documentation demonstrating severe speech impairment and functional communication needs.
Training records demonstrating the member can learn to use the device/software functionally.

Denial Risk

Conditions that trigger denial

Denials will be issued when coverage requirements are not met or when the member cannot demonstrate functional use during training, exhibits significant destructive or aggressive behaviors during training, or when other exclusion conditions apply (e.g., replacements or upgrades within three years without appropriate documentation; duplicate devices/software).

Failure to demonstrate ability to learn/use the device or software functionally during the training schedule or subsequently.
Significant behaviors during training such as physical aggression or property destruction.
Replacements for devices damaged/lost due to neglect, or replacement/upgrade requests less than three years from receipt of initial device without documentation of irreparable non‑neglect damage.
Upgrade requests that do not clearly identify functional benefit and duplicate devices or software (including mounting accessories).
Charges for connectivity, home modifications, and technical support; certain listed devices (voice amplifiers for vocal strain, tracheoesophageal voice prostheses, altered auditory feedback devices) are excluded.

Key Definitions

Speech Generating Device (SGD) — key attributes

DefinitionDurable medical equipment that provides an individual with severe speech impairment the ability to meet functional speaking needs; speech aids consisting of devices or software used solely by the individual.

Intended usersIndividuals with severe expressive speech impairment who require an alternative means to meet functional speaking needs.

Form factorMay be dedicated hardware devices or integrated systems (e.g., configured tablets) that generate speech for the user.

Use limitationDevices and software are intended for sole use by the individual with the speech impairment.

Clinical determinationMedical necessity is determined using InterQual criteria (see coverage criteria).

Speech Generating Software — definition and scope

DefinitionSoftware that enables a desk or laptop computer, tablet, or personal digital assistant (PDA) to function as a speech generating device (SGD).

ScopeIncludes programs that provide digitized or synthesized speech output and message formulation methods when run on general-purpose devices.

DeploymentMay be installed on standard consumer hardware (computers, tablets, PDAs) to convert them into functional SGDs.

Relation to devicesSpeech generating software, when combined with appropriate hardware, constitutes an SGD as defined in policy.