Augmentative and Alternative Communication Systems*
Medical Policy: 01.01.12
Original Effective Date: December 1995
Reviewed: May 2008
Revised:
This policy applies to all products unless specific contract
limitations, exclusions or exceptions apply. Please refer to the member's coverage
manual for benefit availability. Managed care guidelines related to referral authorization,
and precertification of inpatient hospitalization, home health, home infusion and
hospice services apply.
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.
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.
Prior approval is recommended. Submit a prior approval now.
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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.
- Wojtys EM, Huston LJ. “Custom-fit” versus “off-the-shelf” ACL functional braces. Am Journal Knee Surgery 2001 Summer; 14(3): 157-62.
- 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.
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New information or technology that would be relevant for Wellmark to consider when this policy is next reviewed may be submitted to:
Wellmark Blue Cross and Blue Shield
Medical Policy Analyst
Station 304
636 Grand Ave
Des Moines, Iowa 50309
*Prior approval is recommended for this policy.
**Current Procedural Terminology © 2007 American Medical Association. All Rights Reserved.
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