Augmentative and alternative communication (AAC) devices and speech generating devices (SGD) are aids to provide individuals with severe speech impairment or absent speech, the ability to meet their functional communication needs. There may be associated functional disabilities that also limit the individual's ability to use alternative natural methods of communication such as writing notes, using sign language, or even to manipulate a low tech augmentative communication system.

Medically Necessary:

Augmentative and alternative communication and speech generating devices and systems are considered medically necessary when all of the following criteria 1 through 3 are met, and when applicable, criteria 4 or 5 are met:

1. The device has been recommended by the individual's physician and licensed speech language pathologist who has conducted and documented a thorough assessment which includes all of the following information:
   1. 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
   2. Medical justification for the device, and if a high tech* device is requested, it is demonstrated that a low tech* communication device or system is inadequate to meet the individual's functional communication needs; and
   3. Therapeutic history including speech, occupational, or physical therapies as appropriate; and
   4. Documentation of the cognitive ability to utilize the selected device; and 
   5. Documentation of the visual, auditory, language and motor ability to utilize the selected device; and
   6. Documentation of the specific daily functional communication needs; and 
   7. Expected functional communication goals with the device; and 
   8. Plan of care for the device: anticipated training needs, programming needs, evaluations, etc.; AND
2. The individual has severe expressive speech impairment and alternative natural communication methods such as writing or sign language are not feasible or are inadequate for that individual's daily functional communication needs; AND
3. The individual has tested the device, has demonstrated the ability to use the device and there is documentation of the rationale for the specific device selected.
4. If the individual has a degenerative disease causing the speech impairment, the communication device selected should be capable of modification to meet the individual's anticipated needs.
5. If the individual is preliterate but it is anticipated that he or she will be able to learn to read and spell, the communication device selected should in addition have spelling and text capabilities.

*Refer to Discussion/General Information section of the clinical guideline for information on high technology and low technology devices

Accessories are considered medically necessary if criteria for the base device are met and the medical necessity for each accessory is clearly documented in the formal evaluation by the speech language pathologist. For any subsequent upgrade of equipment or accessories to a previously issued device, information regarding the functional benefit to the individual of the upgrade compared to the initially provided device must be submitted to demonstrate medical necessity.

When the above criteria 1 through 3 are met, and when applicable, criteria 4 or 5 are met, specific communication software for dedicated speech generating devices is considered medically necessary.

Not Medically Necessary:

Augmentative communication devices and speech generating devices/systems are considered not medically necessary if the above criteria are not met or if they are not primarily and customarily used to serve a medical purpose.

The following would also be considered not medically necessary:

1. Devices that are not dedicated speech devices, but are devices that are capable of running software for purposes other than for speech generation, e.g. devices that can also run a word processing program or perform other non-medical functions.
2. Laptop computers, desktop computers, or personal digital assistants (PDAs), which may be programmed to perform the same function as a speech generating device.

The following codes for treatments and procedures applicable to this document are included below for informational purposes.  Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy.  Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member. 

Augmentative and alternative communication (AAC) devices/speech generating devices (SGD) are speech aids to provide individuals with severe speech impairment or absent speech, the ability to meet their functional communication needs. Etiologies of speech impairment in children may include cerebral palsy, mental retardation, autism-like disorders and other genetic or speech disorders. Etiologies in adults may include stroke, traumatic brain injury, amyotrophic lateral sclerosis (ALS), Parkinson's disease and head and neck cancers among others. There may be associated functional disabilities that also limit the individual's ability to use alternative natural methods of communication such as writing notes, using sign language, or even to manipulate a low tech augmentative communication system. 

There are numerous communication devices currently available from multiple manufacturers. Low technology, non-electronic AAC devices include boards that use letters, words, phrases and/or symbols (communication boards), mini boards, schedule boards, and conversation books. They may be purchased, homemade, or developed by the speech therapist. 

High technology devices are electronic, generally SGDs, and usually computer-based. Digitized speech generating devices, sometimes referred to as devices with "whole message" speech output use words or phrases that have been recorded by an individual other than the SGD user for playback upon command of the SGD user. The time available for pre-recorded messages varies. Synthesized speech is a technology that translates a user's input into device-generated speech using algorithms representing linguistic rules. Users of synthesized SGDs are not limited to pre-recorded messages, but instead can independently create messages as their communication needs dictate. Some SGDs require a message formulation by spelling, and access by physical contact with a keyboard, touch screen, or other display containing letters. Speech generating software programs enable a laptop computer, desktop computer, or personal digital assistant (PDA) to function as an SGD.

An extra-oral electrolarynx type device (primarily for use post-laryngectomy) consists of a hand-held sound generator which transmits sound waves through the skin and muscle of the neck, vibrating the air column in the vocal tract and allowing for verbal communication. An intra-oral electrolarynx type device is also available, consisting of a handheld control unit transmitting radio waves to an intra-oral radio control circuit which, together with a loudspeaker, is mounted to a denture or orthodontic retainer. It is claimed to produce a more natural sounding voice than other technologies.

Digitalized speech: Devices with "whole message" speech output utilize words or phrases recorded by another individual.

Laryngectomy: Surgical removal of the voice box.

Speech disorder: A condition affecting the ability to produce normal speech may affect articulation (phonetic or phonological disorders); fluency (stuttering or cluttering); and/or voice (tone, pitch, volume, or speed); most speech disorders have their roots in the muscles of the mouth and/or mouth movements.

Speech language pathologist: Another title for a Speech Therapist.

Synthesized speech: A technology that translates a user's input into device-generated speech.

Peer Reviewed Publications:

1. Ansel BM, Weinrich M. Computerized approaches to communication retraining after stroke. Curr Atheroscler Rep. 2002; 4(4):291-295.
2. Downey M, Hurtig R. Augmentative and alternative communication. Pediatr Ann. 2003; 32(7):466-474.
3. Drager KD, Clark-Serpentine EA, Johnson KE, Roeser JL. Accuracy of repetition of digitized and synthesized speech for young children in background noise. Am J Speech Lang Pathol. 2006; 15(2):155-164.
4. Drager KD, Reichle J, Pinkoski C. Synthesized speech output and children: a scoping review. Am J Speech Lang Pathol. 2010; 19(3):259-273..
5. Hustad KC, Keppner K, Schanz A, Berg A. Augmentative and alternative communication for preschool children: intervention goals and use of technology. Semin Speech Lang. 2008; 29(2):83-91.
6. Rispoli M, Franco JH, van der Meer L, et al. The use of speech generating devices in communication interventions for individuals with developmental disabilities: a review of the literature. Dev Neurorehabil. 2010; 13(4):276-293.
7. 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; 32(5):1422-1431.

Government Agency, Medical Society, and Other Authoritative Publications:

1. Centers for Medicare and Medicaid Services. National Coverage Determination: Durable Medical Equipment Reference List. NCD #280.1. Effective May 5, 2005. Available at: http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=280.1&ncd_version=2&basket=ncd%3A280%2E1%3A2%3ADurable+Medical+Equipment+Reference+List. Accessed on May 26, 2011.
2. Centers for Medicare and Medicaid Services. National Coverage Determination: Electronic Speech Aids. NCD #50.2. Effective date not posted. Available at:  http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=50.2&ncd_version=1&basket=ncd%3A50%2E2%3A1%3AElectronic+Speech+Aids. Accessed on May 26, 2011. 
3. Centers for Medicare and Medicaid Services. National Coverage Determination: Speech Generating Devices. NCD #50.1. Effective January 1, 2001. Available at: http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=50.1&ncd_version=1&basket=ncd%3A50%2E1%3A1%3ASpeech+Generating+Devices. Accessed on May 26, 2011.

Augmentative and Alternative Communication (AAC) Devices
Communication Devices
Digital Speech
Speech Generating Devices (SGD)
Speech Impairment
Synthesized Speech