E2513 — Accessory for speech generating device, electromyographic sensor
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- A Standard Written Order (SWO) must be communicated to the supplier before claim submission; for DMEPOS base items requiring Written Order Prior to Delivery (WOPD), a signed WOPD must be received by the supplier before delivery.
- The SLP's formal written evaluation must include at minimum: current communication impairment (type, severity, language skills, cognitive ability, anticipated course), assessment of natural communication options, functional communication goals, treatment options, rationale for device selection, demonstration of treatment plan with training schedule, and documentation of cognitive and physical abilities to use device and accessories.
- For subsequent upgrades to a previously issued SGD, documentation must include information regarding the functional benefit of the upgrade compared to the initially provided SGD.
Key Coverage Criteria
- Beneficiary has a formal written evaluation by a speech-language pathologist (SLP) of cognitive and communication abilities prior to SGD delivery that documents current communication impairment, type, severity, language skills, cognitive ability, and anticipated course.
- SLP written evaluation documents assessment of whether daily communication needs could be met using other natural modes of communication and concludes that the beneficiary's speaking needs cannot be met using natural communication methods.
- SLP written evaluation includes a description of functional communication goals, treatment options, and rationale for selection of the specific SGD and any accessories.
- SLP demonstrates that the beneficiary has a treatment plan that includes a training schedule for the selected device and the cognitive and physical abilities to effectively use the selected device and any accessories to communicate.
- Beneficiary's medical condition results in a severe expressive speech impairment and other forms of treatment have been considered and ruled out.
- The beneficiary's speech impairment is expected to benefit from the ordered device as documented in the SLP evaluation.
6 Active Policies
L33739 — Speech Generating Devices (SGD)
J19
BCBSIL-DME104.009 — Speech Generating Devices (SGD)
BCBSMT-DME104.009 — Speech Generating Devices (SGD)
BCBSNM-DME104.009 — Speech Generating Devices (SGD)
BCBSOK-DME104.009 — Speech Generating Devices (SGD)
Related Codes
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