Humana Speech Generating Devices, Voice Prostheses Form
This procedure is not covered
Description
Speech Generating Devices Speech generating devices (SGDs), also known as augmentative or alternative communication devices, are utilized to help an individual who has a severe speech impairment such as anarthria, aphasia, aphonia, apraxia or dysarthria. The individual may also have an impairment that interferes with writing. SGDs may utilize either digitized or synthesized speech.
Description Digitized SGDs
are those that deliver whole message speech output. These devices deliver words or phrases that have been prerecorded by an individual other than the user of the speech generating device, who can play it back on demand.
Page: 1 of 12 Speech Generating Devices, Voice Prostheses
Effective Date: 09/28/2023
Revision Date: 09/28/2023
Review Date: 09/28/2023
Policy Number: HUM-0405-022
Page: 2 of 12
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
Synthesized SGDs
are those that translate the user’s input into device-generated speech using algorithms representing linguistic rules. Users are not limited to prerecorded messages but can create messages independently according to their communication needs. These devices may also be called text to speech systems and are dedicated to speech generating only and cannot be utilized for any other use, such as tablet-based applications or games. Examples of these devices include, but may not be limited to:
- Accent 800,
- Accent 1000,
- Accent 1400,
- Liberator Rugged 8 (LR8),
- Nova Chat,
- QuickTalker Freestyle and
- Tobii Dynavox I-110.
Voice Prostheses
The electrolarynx (which may also be referred to as a hand-held artificial larynx) remains the most commonly used method for communication following a total laryngectomy. This device has a vibrating head that serves as a sound source for speech, in a similar way that the vocal cords vibrate to produce vocal sounds. When the vibrating head is placed against the neck, it allows for speech in a similar way the larynx (voice box) did, though the sound may be described as a mechanical or robotic sounding voice. Examples of the electrolarynx include, but may not be limited to:
- Nu-Vois (Nu-Vois I, Nu-Vois II Digital, Nu-Vois III Digital, Xtra-Vois I)
- Provox
- SolaTone Plus
- TruTone EMOTE and
- TruTone Plus.
Tracheoesophageal puncture (TEP) voice restoration allows the potential for spontaneous speech production via either an indwelling tracheoesophageal (TE) or nonindwelling TE voice prosthesis, which is suggested to improve the ability to communicate over the telephone and have fewer limitations in interactions with others as compared to the electrolarynx. Examples of indwelling TE voice prosthesis include, but may not be limited to:
- Blom-Singer Indwelling Voice Prosthesis (eg, ADVANTAGE, CLASSIC, Dual Valve, Duckbill and the Low-Pressure Prosthesis) and
- Provox (eg, Provox 2, ActiValve, Vega and Vega XtraSeal).
An example of a nonindwelling voice prosthesis includes, but may not be limited to, Provox NiD.
The UltraVoice speaking device (including the UltraVoice Plus, Ultravoice 2) is a variation of an artificial larynx; it, however, is built into an individual’s denture or a retainer-like appliance, allowing the individual to speak using their mouth, lips and tongue. In addition to the denture/retainer (which includes battery operated components), the individual must carry an operating control box (usually fastened to a belt) to signal the denture/retainer unit to produce sound.
The operating control unit provides on/off signals and pitch as well as inflection and amplification when used in conjunction with a collar microphone, which is also part of the entire system. This device is purported as being the only one of its type to allow the flexibility for the user to contribute to conversation without being restricted to prerecorded responses or typing comments for the SGD to produce.
Fluency Enhancing Devices
Fluency enhancing devices (also known as altered auditory feedback [AAF] devices) generally consist of an earpiece or headphones and an auditory processing unit that is worn around the waist or, with some systems, may be attached to the earpiece itself. How these devices help people who stutter is unclear, but various theories attribute stuttering to an auditory-somatic integration deficit and it is purported that these devices may compensate for the deficit. An example of a fluency enhancing device for stuttering includes, but may not be limited to, the SpeechEasy device. A similar device, the SpeechVive, is used by an individual with Parkinson’s disease to assist in increasing the volume and improving the clarity of speech.
Effective Date: 09/28/2023
Revision Date: 09/28/2023
Review Date: 09/28/2023
Policy Number: HUM-0405-022
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Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
Coverage Determination
Many Humana Plans exclude coverage of SGDs (communication devices) EXCEPT for those members who have had surgical removal of the larynx or a diagnosis of permanent lack of function of the larynx. Please refer to the member’s individual certificate.
Speech Generating Devices
Humana members may be eligible under the Plan for SGDs (digitized or synthesized speech) for those plans that do not address or specifically exclude communication devices when the following criteria are met:
- Prior to the approval of the SGD, the individual has had a formal evaluation of their cognitive and language abilities by a speech-language pathologist (SLP). The formal, written evaluation must include, at a minimum, ALL of the following elements:
- An evaluation of current communication impairment, including the type, severity, language skills, cognitive ability and anticipated course of the impairment; AND
- Assessment of whether the individual’s daily communication needs could be met using other natural modes of communication; AND
- Demonstration that the individual possesses the cognitive and physical abilities to effectively use the selected device and any accessories to communicate; AND
- Description of the functional communication goals expected to be achieved and treatment options; AND
- For a subsequent upgrade to a previously issued SGD, information regarding the functional benefit to the individual for the upgrade compared to the initially provided SGD; AND
- Rationale for selection of a specific device and accessories (coverage is limited to a BASIC SGD); AND
- Treatment plan that includes a training schedule for the selected device; AND
- A copy of the SLP’s written evaluation and recommendations has been forwarded to the individual’s treating physician for review prior to ordering the device; AND
- Other forms of treatment have been considered and ruled out; AND
- The individual’s medical condition is one resulting in a permanent severe expressive speech disability including, but not limited to, anarthria, aphasia, aphonia, apraxia or dysarthria; AND
- The individual’s speaking needs cannot be met using natural communication methods; AND
- The individual’s speech disability will benefit from the device ordered; AND
- The SLP performing the evaluation of the individual may not be an employee or have a financial relationship with the supplier of the SGD.
Effective Date: 09/28/2023
Revision Date: 09/28/2023
Review Date: 09/28/2023
Policy Number: HUM-0405-022
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Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
Software that enables a laptop computer, desktop computer, smart phone, tablet device (eg, iPad, Kindle, etc.) or personal digital assistant (PDA) to function as an SGD is covered as an SGD if the above criteria are met; however, installation of the program or technical support is not separately reimbursable.
Humana members may be eligible under the Plan for a speech generating device mounting system for a wheelchair when the above criteria for a SGD have been met. For information regarding the coverage determination/limitations for wheelchairs, please refer to Mobility Assistive Devices Medical Coverage Policy.
Note: The criteria for speech generating devices are not consistent with the Medicare National Coverage Policy and therefore may not be applicable to Medicare members.
Refer to the CMS website for additional information.
Voice Prostheses
Humana members may be eligible under the Plan for an electrolarynx (artificial larynx) or a transesophageal puncture (TEP) system (tracheoesophageal voice prosthesis) for those plans that do not address or specifically exclude communication devices when the following criteria are met:
- Individual has had a total laryngectomy; AND
- Prior to the approval of the voice prosthesis, the individual has had a formal evaluation of their cognitive and language abilities by an SLP; AND
- The individual has adequate pulmonary function to force air from the trachea through the prosthesis into the esophagus; AND
- The individual has the manual dexterity to use and care for the device; AND
- Subsequent upgrade to a previously issued voice prosthesis: information must be provided regarding the functional benefit to the individual of the upgrade compared to the initially provided device
Effective Date: 09/28/2023
Revision Date: 09/28/2023
Review Date: 09/28/2023
Policy Number: HUM-0405-022
Page: 6 of 12
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
Humana members may be eligible under the Plan for replacement of an indwelling TEP system every three to six months (this is generally performed as an outpatient procedure).
Coverage Limitations
Humana members may NOT be eligible under the Plan for SGDs for any indications other than those listed above. All other indications are considered not medically necessary as defined in the member’s individual certificate. Please refer to the member’s individual certificate for the specific definition.
Humana members may NOT be eligible under the Plan for SGDs for autism spectrum disorders (ASD). These are considered experimental/investigational as they are not identified as widely used and generally accepted for the proposed uses as reported in nationally recognized peer-reviewed medical literature published in the English language.
Humana members may NOT be eligible under the Plan for the following SGDs as they do not meet the definition of durable medical equipment (DME):
- A device that is useful to someone without a severe speech impairment is not considered to be a SGD; OR
- Devices that are not dedicated speech devices, but are devices that are capable of running software for purposes other than for speech generation (eg, devices that can also run a word processing package, an accounting program or perform other nonmedical functions); OR
- Internet or phone services or any modification to a home to allow use of the SGD, including any computing hardware or software not necessary to allow for generation of audible/verbal speech, email, text or other function a computer can perform that is not directly related to meeting the functional speaking communication needs of the individual, including video communications or conferencing; OR
- Laptop computers, tablet devices (eg, iPad, Kindle, etc.), smart phones, desktop computers or PDAs, which may be programmed to perform the same function as
Effective Date: 09/28/2023
Revision Date: 09/28/2023
Review Date: 09/28/2023
Policy Number: HUM-0405-022
Page: 7 of 12
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version.
Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
a speech generating device, are not covered as they are not primarily medical in nature and do not meet the definition of DME
These are considered not medically necessary as defined in the member’s individual certificate. Please refer to the member’s individual certificate for the specific definition.
Humana members may NOT be eligible under the Plan for an electrolarynx or a transesophageal puncture (TEP) system for any indications other than those listed above. All other indications are considered not medically necessary as defined in the member’s individual certificate. Please refer to the member’s individual certificate for the specific definition.
Humana members may NOT be eligible under the Plan for the following devices for any indications:
- Fluency enhancing devices including, but not limited to the SpeechEasy device for stuttering or the SpeechVive device for Parkinson’s disease; OR
- UltraVoice system voice prosthesis
These are considered not medically necessary as defined in the member’s individual certificate. Please refer to the member’s individual certificate for the specific definition.
Humana members may NOT be eligible under the Plan for replacement batteries for speech generating devices for any indication. Although they may be prescribed by a health care practitioner, batteries are also available without a prescription and may be obtained over-the-counter (OTC) and are therefore generally contractually excluded. In the absence of a contractual exclusion for OTC items, batteries are considered not medically necessary as defined in the member’s individual certificate. Please refer to the member’s individual certificate for the specific definition.
Effective Date: 09/28/2023
Revision Date: 09/28/2023
Review Date: 09/28/2023
Policy Number: HUM-0405-022
Page: 8 of 12
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
Additional information about anarthria, aphasia, aphonia, apraxia, dysarthria or other speech impairments may be found from the following websites:
Background
- American Speech-Language-Hearing Association
- National Institute on Deafness and Other Communications Disorders
- National Library of Medicine
Medical Alternatives
Physician consultation is advised to make an informed decision based on an individual’s health needs.
Any CPT, HCPCS or ICD codes listed on this medical coverage policy are for informational purposes only. Do not rely on the accuracy and inclusion of specific codes. Inclusion of a code does not guarantee coverage and or reimbursement for a service or procedure.
sas patient; each additional 30 minutes (List separately in addition to code for primary procedure)
| 92609 | Therapeutic services for the use of speech-generating device, including programming and modification | |
| CPT® Category Ill Code(s): | Description | Comments |
Speech Generating Devices, Voice Prostheses
Effective Date: 09/28/2023
Revision Date: 09/28/2023
Review Date: 09/28/2023
Policy Number: HUM-0405-022
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HCPCS Code(s)
Description
Comments
| E1399 | Durable medical equipment, miscellaneous | Not Covered if used to report any SGD outlined |
|---|---|---|
| £2500 | Speech generating device, digitized speech, using prerecorded messages, less than or equal to eight minutes recording time | |
| E2502 | Speech generating device, digitized speech, using prerecorded messages, greater than eight minutes but less than or equal to 20 minutes recording time | |
| E2504 | Speech generating device, digitized speech, using prerecorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time | |
| £2506 | Speech generating device, digitized speech, using prerecorded messages, greater than 40 minutes recording time | |
| E2508 | Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device | |
| E2510 | Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access | |
| £2511 | Speech generating software program, for personal computer or personal digital assistant | |
| E2512 | Accessory for speech generating device, mounting system | |
| E2599 | Accessory for speech generating device, not otherwise classified | |
| K1009 | Speech volume modulation system, any type, including all components and accessories | Not Covered |
| L8499 | Unlisted procedure for miscellaneous prosthetic services | Not Covered if used to report any SGD outlined in Coverage Limitations |
Not Covered if used to report any SGD outlined in Coverage Limitations section
Speech Generating Devices, Voice Prostheses
Effective Date: 09/28/2023
Revision Date: 09/28/2023
Review Date: 09/28/2023
Policy Number: HUM-0405-022
Page: 10 of 12
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version.
Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
| L8500 | Artificial larynx, any type | Not Covered if used to report any SGD outlined in Coverage Limitations section |
|---|---|---|
| L8505 | Artificial larynx replacement battery/accessory, any type | Not Covered |
| 18507 | Tracheo-esophageal voice prosthesis, patient inserted, any type, each | |
| 18509 | Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type | |
| L8510 | Voice amplifier | Not Covered |
| 18511 | Insert for indwelling tracheo-esophageal prosthesis, with or without valve, replacement only, each | |
| 18512 | Gelatin capsules or equivalent, for use with tracheo-esophageal voice prosthesis, replacement only, per 10 | |
| 18513 | Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each | |
| L8514 | Tracheo-esophageal puncture dilator, replacement only, each | |
| 18515 | Gelatin capsule, application device for use with tracheo- esophageal voice prosthesis, each | |
| V5336 | Repair/modification of augmentative communicative system or . . . . device (excludes adaptive hearing aid) | |
| V5362 | Speech screening | |
| V5363 | Language screening |
References
- American Academy of Neurology (AAN). Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: multidisciplinary care, symptom management, and cognitive/behavioral impairment (an evidence- based review). https://www.aan.com. Published October 13, 2009. Updated January 11, 2020. Accessed August 28, 2023.
- American Academy of Pediatrics (AAP). Clinical Report. Prescribing assistive- technology systems: focus on children with impaired communication. https://www.aap.org. Published June 2008. Updated June 2018. Accessed August 28, 2023.
- American Speech-Language-Hearing Association (ASHA). Augmentative and alternative communication. https://www.asha.org. Accessed August 28, 2023.
- American Speech-Language-Hearing Association (ASHA). Communication after total laryngectomy. https://www.asha.org. Accessed August 28, 2023
- Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD). Speech generating devices (50.1). https://www.cms.hhs.gov. Published July 29, 2015. Accessed August 28, 2023.
- ECRI Institute. Clinical Evidence Assessment. SpeechVive (SpeechVive, Inc.) for assisting speech in patients with Parkinson’s disease. https://www.ecri.org. Published April 13, 2021. Accessed August 28, 2023.
- ECRI Institute. Hotline Response (ARCHIVED). Augmentative and alternative communication for nonspeaking individuals. https://www.ecri.org. Published May 11, 2016. Accessed August 11, 2021.
- ECRI Institute. Hotline Response (ARCHIVED). Fluency-enhancing devices for stuttering. https://www.ecri.org. Published April 13, 2009. Accessed April 24, 2012.
- Hayes, Inc. Evidence Analysis Research Brief (ARCHIVED).
Speech Generating Devices, Voice Prostheses
Effective Date: 09/28/2023
Revision Date: 09/28/2023
Review Date: 09/28/2023
Policy Number: HUM-0405-022
Page: 11 of 12
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
- Hayes, Inc. Health Technology Brief (ARCHIVED). SpeechVive for management of speech disorders related to Parkinson disease. https://evidence.hayesinc.com. Published November 6, 2020. Accessed August 28, 2023.
- Hayes, Inc. Health Technology Brief (ARCHIVED). Speech-generating devices for treatment of dysarthria. https://evidence.hayesinc.com. Published October 3, 2008. Updated October 14, 2010. Accessed August 28, 2023.
- Hayes, Inc. Health Technology Brief (ARCHIVED). SpeechEasy (Janus Developmental Group Inc.) for treatment of stuttering. https://evidence.hayesinc.com. Published August 4, 2009. Updated July 25, 2011. Accessed August 28, 2023.
- Hayes, Inc. Search & Summary (ARCHIVED). DynaVox Maestro (DynaVox Mayer-Johnson) communication device for individuals with speech and language disabilities. https://evidence.hayesinc.com. Published May 17, 2012. Accessed May 1, 2014.
- Hayes, Inc. Search & Summary (ARCHIVED). Speech generating devices for autism. https://evidence.hayesinc.com. Published December 15, 2016. Accessed March 29, 2018.
- MCG Health. Augmentative communication devices, electronic. 27th edition. https://www.mcg.com. Accessed August 28, 2023.
- UpToDate, Inc. Alaryngeal speech rehabilitation. https://www.uptodate.com. Updated July 2023. Accessed August 28, 2023.
- UpToDate, Inc. Aphasia: prognosis and treatment. https://www.uptodate.com. Updated July 2023. Accessed August 28, 2023.
- UpToDate, Inc. Evaluation and treatment of speech and language disorders in children. https://www.uptodate.com. Updated July 2023. Accessed August 28, 2023.
Speech Generating Devices, Voice Prostheses
Effective Date: 09/28/2023
Revision Date: 09/28/2023
Review Date: 09/28/2023
Policy Number: HUM-0405-022
Page: 12 of 12
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.