Augmentative and Alternative Communication Systems
Medical Policy: 01.01.12
Original Effective Date: December 1995
Reviewed: March 2012
Revised:
Benefit Application
Benefit determinations are based on the applicable contract language in effect at the time the
services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary
based on contract, and individual member benefits must be verified. Wellmark determines medical
necessity only if the benefit exists and no contract exclusions are applicable. This medical
policy may not apply to FEP. Benefits are determined by the Federal Employee Program.
This Medical Policy document describes the status of medical technology at the time the document
was developed. Since that time, new technology may have emerged or new medical literature may
have been published. This Medical Policy will be reviewed regularly and be updated as scientific
and medical literature becomes available.
Description:
Augmentative and alternative communication systems are also known as speech generating devices. These are prescribed for patients who are unable to functionally use natural oral speech as a primary means of communication due to severe expressive communication disorders. These devices have been described as a method to help those patients who do not have the potential to develop functional communication.
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Prior Approval:
Not applicable
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Policy:
An augmentative communication system may be considered medically necessary when all of the following conditions are met:
- The patient is unable to functionally communicate in any other way
- The patient's functional capability or potential is consistent with the selected device
- A speech-language diagnosis and physical status are documented
- Information regarding the device, justification for the particular device selected and the patient's prognosis are all documented.
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Procedure Codes and Billing Guidelines:
- To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9 diagnostic codes.
- Augmentative and alternative communication systems should be billed with unlisted procedure code E1399.
- HCPCS codes E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512, and E2599 should be used, as appropriate codes, for the service provided. Professional services should be billed with CPT codes 92597, 92607, 92608, 92609.
- HCPCS code E1902 should be used to report communication board, non-electronic augmentative or alternative communication devices.
- Any accessories required for use of the selected device must be listed and documentation submitted for prior approval must justify the need for each accessory.
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Selected References:
- The literature search and consultants’ comments on this issue.
- Ansel BM, Weinrich M. Computerized approaches to communication retraining after stroke. Current Atherosclerosis Reports 2002;4:291-295.
- Craig A, Moses P, Tran Y, McIsaac P, Kirkup L. The effectiveness of a hands-free environmental control system for the profoundly disabled. Arch Phys Med Rehabil 2002;83:1455-1458.
- Dickerson SS, Stone VI, Panchura C, Usiak DJ. The meaning of communication: Experience with augmentative communication devices. Rehabilitation Nursing 2002 27(6):215-220.
- Wood D. Talking again with the help of a communication device. EBSCO Health Library. Ipswich, MA: EBSCO Publishing; 2005. Available at: http://healthlibrary.epnet.com/print.aspx?token=723d4f33-4765-4183-9518-055337ce86f8&chunkiid=24025.
- Agency for HealthCare Research and Quality (AHRQ). Evidence Report/Technology Assessment. No. 52. Criteria for determining disability in speech-language disorders (Summary). Revised 2002. Available to URL address: http://www.ahrq.gov/clinic/epcsums/spdissum.htm
- Brownlee A, Palovcak M. The role of augmentative communication devices in the medical management of ALS. NeuroRehabilitation. 2007;22(6):445-450.
- Lund SK, Light J. Long-term outcomes for individuals who use augmentative and alternative communication: part I--what is a "good" outcome? Augment Altern Commun. 2006 Dec; 22(4):284-99.
- Desch LW, Gaebler-Spira D; Council on Children with Disabilities. Prescribing assistive-technology systems: focus on children with impaired communication. Pediatrics. 2008 Jun;121(6):1271-80.
- ECRI Institute. Augmentative Communication Devices for Nonspeaking Individuals. Plymouth Meeting (PA): ECRI Institute; 2009 March 18. 8 p. [ECRI hotline response.] Also available: http://www.ecri.org
- van der Meer L, Sigafoos J, O’Reilly MF, Lancioni GE. Assessing preferences for AAC options in communication interventions for individuals with developmental disabilities: a review of the literature. Res Dev Disabil. 2011 Sep-Oct;32(5):1422-31.
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Policy History:
Date Reason Action
May 2011 Annual review Policy renewed
March 2012 Annual review Policy renewed
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of technology assessment of new and emerging treatments, devices,
drugs, etc. They are developed to
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and therefore are subject to change without notice.
*Current Procedural Terminology © 2012 American Medical Association. All Rights Reserved.
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