Background As of January 1, 2001, Medicare has covered and provided reimbursement for some Speech Generating Devices or "SGDs". This coverage coincided with the withdrawal of a long-standing guidance that referred to AAC devices (SGDs) as "convenience items."
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Who Qualifies? Medicare now classifies SGDs as "durable medical equipment," and they are available to Medicare beneficiaries when the following four criteria are met:
1) the beneficiary is enrolled in Medicare Part B;
2) the beneficiary lives in his/her family home, or an assisted living facility (but not in a hospital, skilled nursing facility, or hospice);
3) the beneficiary is determined, following an assessment by a speech-language pathologist, to require an SGD to meet daily functional communication needs; and
4) the beneficiary's physician prescribes the SGD.
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What is the RMRP Policy? Medicare has issued a Regional Medical Review Policy (RMRP) on Speech Generating Devices (SGDs) that identifies the required components of the SLP evaluation and report.
Click here for a complete copy of the RMRP.
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What is the SGD Assessment /Application Protocol ? This SGD Assessment Protocol is intended as a guide so that speech-language pathologists will conduct complete assessments and prepare written reports that address all of the points identified in the RMRP.
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Who Can Conduct the Assessment? The RMRP requires that a speech-language pathologist holding a Certificate of Clinical Competence issued by the American Speech-Language-Hearing Association conduct the assessment for an SGD.
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Can the Assessment be Reimbursed? Yes. Medicare has established procedure codes and reimbursement rates for SGD assessments and devices. However, in order to be reimbursed, the SLP must meet the requirements to be a provider of Medicare speech-language pathology services.
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Must a Written Report be Prepared? Yes. The SLP report, consistent with the RMRP, must be completed, and then sent to the beneficiary's doctor for review. A doctor's prescription is needed to obtain reimbursement for the recommended SGD and any software and accessories. This Assessment /Application Protocol identifies the specific topics to be addressed in the report.
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Is Additional Help Available? Yes. SLPs with questions about the SGD Assessment Protocol may contact members of the Medicare Implementation Team. Contact information is listed at the end of the Protocol. To obtain more information about Medicare coverage of SGDs, go to "Frequently Asked Questions."
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NOTE : If you have a specific question or comment regarding the Medicare Assessment or Application Process for SGD not addressed on this site, we invite you to contact us through our Medicare Assessment / Application Process Feedback Page .
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