E1902, Communication board, non-electronic augmentative or alternative communication
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Documentation of a clinical or genetic diagnosis demonstrating the child has a disease/syndrome/disorder that includes low tone neuromuscular impairment, neurological impairment, or cognitive impairment.
- Clinical justification that the requested therapy, diagnostic testing, or equipment is necessary to increase the child’s quality of life (treatment goals, functional impact, prior treatments tried).
- Proof of plan type and effective/renewal date when relevant to confirm the plan was amended/delivered/issued/renewed on or after 2025-01-01 (to establish applicability).
- Formal written evaluation by an SLP of cognitive and communication abilities completed prior to SGD delivery; the written evaluation must include the policy's required elements (elements not provided in this excerpt).
Key Coverage Criteria
- Type and number of symbols/pictures and/or words used with each device trial;and
- Extent to which individual can independently navigate the device.
- Augmentative and alternative communication devices with digitized or synthesized speech output are consideredmedically necessarywhenallof the following criteria A through C are met,andwhen applicable, criteria D or E are met:
- The device has been recommended by the individualâs physicianandlicensed speech language pathologist who have each conducted and documented a thorough assessment which includes all of the following information:Medical diagnosis, physiological description of the underlying disorder, description of functional limitation, nature and severity of speech or communication impairment, and prognosis for improvement (or deterioration);andMedical justification for the device and documentation that a non- [...]
- Medical diagnosis, physiological description of the underlying disorder, description of functional limitation, nature and severity of speech or communication impairment, and prognosis for improvement (or deterioration);and
- Medical justification for the device and documentation that a non-electronic communication device (such as a communication board) is inadequate to meet the individualâs functional communication needs;and
6 Active Policies
ANTHEM-CG-DME-07, CG-DME-07 Augmentative and Alternative Communication (AAC) Devices with Digitized or Synthesized Speech Output
DME104.009, Speech Generating Devices (SGD)
BCBSIL-DME104.009, Speech Generating Devices (SGD)
BCBSMT-DME104.009, Speech Generating Devices (SGD)
BCBSNM-DME104.009, Speech Generating Devices (SGD)
Related Codes
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