PROPOSED WORDING FOR AAC DEVICE NATIONAL COVERAGE DECISION
Augmentative & Alternative Communication Devices
E xxx 1 AAC devices with digitized speech output
E xxx 2 AAC devices with synthesized speech output, which require message formulation by spelling and device access by physical contact direct selection techniques
E xxx 3 AAC devices with synthesized speech output, which permit multiple methods of message formulation and multiple methods of device access
E xxx 4-1 AAC Accessories: access technologies, direct and indirect
E xxx 4-2 AAC Accessories: mounting systems
E xxx 4-3 AAC Accessories: carrying cases
E xxx 4-4 AAC Accessories: power supplies
E xxx 4-5 AAC Software
HCPCS Modifiers for AAC devices with digitized speech output
ZV AAC devices with digitized speech output with less than 4 minutes recording time
ZW AAC devices with digitized speech output with 4- 8 minutes recording time
ZX AAC devices with digitized speech output with 9-16 minutes recording time
ZY AAC devices with digitized speech output with 17-32 minutes recording time
ZZ AAC devices with digitized speech output with more than 32 minutes recording time
Benefit Category Durable Medical Equipment
Augmentative & Alternative Communication (AAC) devices are electronic devices that provide treatment for severe dysarthria, apraxia of speech, or aphasia, when, due to those communication impairments, an individual is not able to meet the communication needs that arise in the course of current and projected future daily activities. AAC devices are covered as durable medical equipment when incorporated into a speech language pathology treatment plan, and when it is determined by a speech-language pathology assessment that an individual is unable to meet the communication needs arising in the course of daily activities using natural communication techniques.
AAC devices include electronic devices that are: a) dedicated communication devices; and b) portable computers that have been modified to serve as an individuals communication device. The term AAC accessories means device-related components, software, and accessories that are necessary additions to an AAC device, based on the nature and severity of the beneficiarys disability, to permit its effective and efficient use.
An AAC device will be covered by Medicare as an item of durable medical equipment when all of the following are met: a) the AAC device is recommended by a speech-language pathologist in a narrative report based on a complete assessment; b) it is incorporated into a speech-language pathology treatment plan stating the functional communication goals to be achieved with the AAC device; c) it is prescribed by the beneficiarys physician; and d) it is supported by a completed certificate of medical necessity.
Coverage and Payment Rules
Code E xxx1 is covered if the patient meets:
a. criteria 1-3 but not
b. criteria 4, 5 and 6
Code E xxx2 is covered if the patient meets:
a. criteria 1-5 and 7 but not
b. criteria 6, 8, and 9
Code E xxx3 is covered if the patient meets:
a. criteria 1-3 and
b. criteria 4 and 6
The speech-language pathologists narrative report also must establish whether an individual for whom HCPCS Code E xxx 1-3 will require any AAC accessories.
For accessory code E xxx 4-5 to be covered, the patient must meet criteria 4 and 6 as listed above, and the certificate of medical necessity must specifically establish that the individual has access to specially adapted computer components and adaptations that will permit the individuals needs to be met solely by the use of AAC software.
Appropriate use of the Z_ modifier is the responsibility of the supplier billing the DMERC. This modifier identifies the device that fits within the HCPCS code Exxx1.
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