This policy version was replaced April 3, 2023. To find the newest version, go to https://www.bluecrossmn.com/providers/medical-policy-and-utilization-management, read and accept the Blue Cross Medical Policy Statement, then select “Blue Cross and Blue Shield of Minnesota Medical Policies.” This will bring up the Medical Policy search screen. Enter the policy number without the version number (last 3 digits).

A speech generating device (SGD) consists of hardware and/or software that generates speech and is used solely by the individual who has a severe speech impairment. These devices generate speech using one of the following methods:

• Digitized audible/verbal speech output, using prerecorded messages; 
• Synthesized audible/verbal speech output which requires message formulation by spelling and device access by physical contact with the device-direct selection techniques;
• Synthesized audible/verbal speech output which permits multiple methods of message formulation and multiple methods of device access; or
• Software that allows a computer or other electronic device to generate audible/verbal speech.

Definitions:

Speech-Language Pathologist (SLP) is a licensed health professional educated at the graduate level in the study of human communication, its development and its disorders. An SLP holds a Certificate of Clinical Competence (CCC) in speech-language pathology from the American Speech-Language-Hearing Association (ASHA). 

Digitized speech is a device with whole message speech output. It utilizes words or phrases that have been recorded by an individual other than the SGD user for playback upon command of the SGD user.

Synthesized speech is a technology that translates a user's input into device-generated speech. Users of synthesized speech SGDs are not limited to re-recorded messages but rather can independently create messages as their communication needs dictate.

Personal Digital Assistants are handheld devices that integrate the functions of a small computer with features such as a cell phone, personal organizer, electronic mail or pager. Information may be input via a pen-based system using a stylus and handwriting recognition software, keyboard or downloaded from a personal computer using special cables and software.

Speech generating software programs enable a laptop computer, desktop computer or PDA to function as an SGD. Within this policy, the term SGD also describes these speech generating software programs.

I.    Initial Request

A speech generating device (SGD) may be considered MEDICALLY NECESSARY AND APPROPRIATE when ALL the following criteria are met:

• The patient has one of the following conditions: 
  • Anarthria 
  • Aphasia 
  • Aphonia 
  • Dysarthria 
  • Persistent speech impairment associated with an autism spectrum disorder or pervasive developmental disorder 
• AND 
• The patient’s ability to communicate daily functional needs (e.g. ability to describe hunger, thirst, pain or hygiene) cannot be met using natural communication methods (e.g., gestures, speech, and/or written communication; AND
  
• Other forms of treatment have been considered and ruled out; AND
• The patient will gain intelligible speech with the device despite the patient's communication impairment as demonstrated by a one-month trial therapy utilizing the device prior to purchase; AND
• Prior to ordering of the device, patient has had a formal evaluation of their cognitive and communication abilities by a speech-language pathologist (SLP); AND
• The SLP performing the patient evaluation has no financial relationship with the supplier of the SGD.

II.   Options and Accessories

Options and accessories may be considered MEDICALLY NECESSARY AND APPROPRIATE when:

• Both of the following are met:
  • The patient meets all medical necessity criteria in section I; and
  • Medical necessity is clearly documented in the evaluation by the SLP;
• AND
• One or more of the following are required:
  • Optical head pointer;
  • Joystick;
  • SGD scanning device switch;
  • Mounting system necessary to place the SGD device, switches, and other access devices within reach of the patient;
  • Protective cover or carrying case for a device without a mounting system;
  • Electronic power wheelchair/SGD interface;
  • Replacement accessories such as batteries, battery chargers and AC adapters;

III.  Device Upgrades

Upgrades to an SGD may be considered MEDICALLY NECESSARY AND APPROPRIATE when ALL the following criteria are met:

• All medical necessity criteria in section I are met; AND
• Medical necessity is clearly documented in the evaluation by the SLP; AND
• Upgrade of a device will provide functional benefit to the patient compared to the current device. Examples include but are not limited to eye tracking and gaze interaction accessories.

IV.  Not Medically Necessary

The following are considered NOT MEDICALLY NECESSARY:

• Laptop computers, desktop computer or other devices that are not dedicated SGDs;
• Specific features of a speech generating device that are not used by the individual to meet his or her functional speaking needs;
• Devices that allow the patient to communicate messages to others with writing (e.g., a display screen or printout) rather than synthesized speech;
• Devices that allow the user to communicate with a computer rather than with another person including but not limited to video communication and conferencing;
• More than one SGD;
• Communication aids that are not SGDs, as they are not prosthetics for speech. These include but are not limited to the following:
  • Picture books;
  • Flash cards;
  • Braille typewriters;
  • Text telephone or telecommunication device for the deaf (TDD).

Coverage

The following are INELIGIBLE FOR COVERAGE as they are considered convenience items:

• Devices requested for the sole purpose of education;
• Environmental control devices such as switches, control boxes or battery interrupters;
• Telephones, smartphones or cell phones;
• Modification, construction, programming or adaptation of dedicated speech generating devices; 
• Services or modifications that could be used for non-medical equipment including but not limited to Wi-Fi, internet service provider (ISP), phone service subscriptions or any modification to a patient’s home;
• Applications, software or programs not recommended by the speech-language pathologist;
• Hardware or software used to create documents and spreadsheets; or play games or music;
• Carrying case when a mounting system has been provided;
• Accessories used with non-covered devices.

Documentation Submission

Documentation supporting the medical necessity criteria described in the policy must be included in the prior authorization, when prior authorization is needed. The following must be submitted:

• Clinical notes including:
  • A formal written evaluation from the SLP that includes, at a minimum, ALL of the following:
    • Current communication impairment, including the type, severity, language skills, cognitive ability, and anticipated course of the impairment; and 
    • An assessment of whether the individual's daily communication needs could be met using other natural modes of communication (gestural, speech, and/or written communication); and
    • A description of the functional communication goals expected to be achieved and the treatment options; and
    • Rationale for selection of a specific device and any accessories; and
    • Demonstration that the patient possesses a treatment plan that includes a training schedule for the selected device; and
    • Patient has the cognitive and physical abilities to effectively use the selected device and any accessories to communicate;
  • AND
  • A copy of the SLP's written evaluation and recommendation has been forwarded to the patient's treating physician prior to ordering the device.

Link to Pre-Authorization Form:  https://www.bluecrossmn.com/sites/default/files/DAM/2021-12/BCBSMN-Pre-Auth-Request-fillable-X18509R07.pdf