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Augmentative Communication Devices

Revised: 04-27-2016

  • Overview
  • Eligible Providers
  • Eligible Recipients
  • Covered Services
  • Non-covered Services/Items
  • Authorization Requirements
  • Billing
  • References
  • Overview

    Augmentative communication or speech-generating devices are devices dedicated to transmitting or producing messages or symbols in a manner that compensates for the impairment and disability of a recipient with severe expressive communication disorders and limitations.

    Eligible Providers

    Augmentative communication (AC) devices are obtained from any of the following enrolled MHCP providers:

  • • Medical equipment and supply providers
  • • Outpatient hospitals
  • • AC device manufacturers
  • Eligible Recipients

    Recipients of Medical Assistance (MA) and MinnesotaCare are eligible.

    Covered Services

    Minnesota Health Care Programs (MHCP) cover speech-language pathology and related services, including AC devices and related accessories.

    AC devices include, but are not limited to:

  • • Communication picture books
  • • Communication charts and boards
  • • Mechanical devices
  • • Electronic devices
  • • Electronic tablets
  • • Communication software application
  • MHCP covers only one speech-generating device approved and purchased through MHCP. AC devices must be dedicated for speech communication use. Tablets must be locked to prevent use not related to communication, with the exception of certain waiver covered services as defined in Specialized Supplies and Equipment in the Waiver Programs section of the Community-Based Services Manual.

    Accessories may include the following:

  • • A carrying case
  • • A mounting system and hardware
  • • A protective case for non-dedicated tablets
  • • Other accessories determined to be medically necessary
  • MHCP will cover services necessary to set-up and maintain non-dedicated electronic tablets including:

  • • Registering the device
  • • Downloading software
  • • Updating software application
  • Coverage Criteria
    To be covered as a rehabilitative and therapeutic service, the recipient’s physician must prescribe an AC device. The speech-language pathologist must specify the device in a plan of care (POC) that is reviewed and revised as medically necessary by the recipient’s physician, or other licensed practitioner of the healing arts.

    Speech-language pathologists, occupational therapists and physical therapists and other professionals collaborate in preparing the required authorization documentation submitted by the equipment supply provider, outpatient hospital, or device manufacturer.

    Electronic Tablets as AC Devices
    MHCP covers electronic tablets when they are to be used as augmentative communication (AC) devices. A tablet used for this purpose is considered durable medical equipment (DME) and must be dedicated for a recipient’s communication needs.

    Recipients may now obtain these commonly used types of tablet computers directly through MHCP-enrolled DME suppliers. Examples include the Apple iPad®. These tablets are not designed specifically to be used as AC devices and require added communication software for AC use. For MHCP to cover, the tablet must be locked to prevent use not related to augmentative communication, unless the tablet is also used for services covered under a recipient’s waiver.

    Some manufacturers who have been makers of conventional AC devices have introduced tablets specifically for use as speech-generating devices; these are referred to as “traditional” tablets. Traditional tablets are designed to be used as AC devices and come with their own software.

    Electronic tablets used as AC devices must meet the same coverage criteria as other devices. In addition, they must meet the following:

  • • The recipient’s speech language pathologist (SLP) must determine the tablet and software application that is the most appropriate, cost-effective choice for a recipient’s communication needs
  • • The tablet must be locked to prevent use not related to communication. Locking features include Parental Controls and Guided Access (for iPad®) or other comparable feature for other tablets
  • Speech-language pathologist’s responsibilities
    The SLP determines the communication needs of the recipient through an evaluation and device trials. If the SLP recommends a non-traditional style tablet, the SLP will complete and send the request and medical documentation to an MHCP-enrolled DME supplier who obtains the tablet through their distributors and provides it for the recipient. Based on the recipient’s existing support system, the SLP must also identify who is responsible for all of the following:

  • • Setting up the device account and registration
  • • Purchasing and downloading the speech software application and updating as needed
  • • Enabling the device’s accessibility feature (such as Guided Access for iPad®)
  • • Keeping a record of the passcode
  • • Upgrading the device’s operating system when required
  • • Handling or ordering repairs
  • This information must be included in the recipient’s Plan of Care and the DME supplier’s records. To comply with Minnesota Statutes, the recipient’s therapist, the DME supplier or another responsible party will retain the passcode used to lock the device or application.

    DME supplier’s responsibilities

    The DME supplier is responsible for submitting the authorization for a tablet they intend to supply.

    If authorization is approved, the supplier does the following:

  • • Orders and purchases the tablet, software and accessories
  • • Prepares it for the recipient’s use
  • Delivers it to the SLP or recipient
  • • Bills MHCP for the equipment
  • Noncovered Services and Items

    MHCP does not cover the following:

  • • AC or speech-generating devices requested for the sole purpose of education
  • • Environmental control devices such as switches, control boxes or battery interrupters
  • • Modification, construction, programming, or adaptation of dedicated communication systems or devices
  • • Repairs, cleaning or other services for devices that are not dedicated communication devices
  • • Upgrading to new technology that is not proven to be medically necessary
  • • Replacing devices based on manufacturer’s recommended replacement schedule, for example, every 5 years
  • • Facilitated communication: a technique by which a "facilitator" provides physical and other supports in an attempt to assist a person with a significant communication disability to point to pictures, objects, and printed works or letters (MHCP does not cover facilitated communication by any provider)
  • • Personal computers, laptop computers, and other personal media players that are not dedicated communication devices
  • • Portable, electronic devices that are not designated to have a primary use as AC devices
  • • Telephones, smartphones or cell phones
  • • Carrying cases when a mounting system has been provided
  • • Applications, software or programs not recommended by the speech-language pathologist or that are not designated to have primary use as a communication tool
  • • More than one speech-generating device funded through MHCP
  • • Extended warranties
  • • Wi-Fi or Internet service
  • Authorization Requirements

    Device Purchase, Repairs, Rental and Replacement
    Authorization is always required for the following:

  • • All AC device purchases
  • • Mounting systems exceeding $400
  • Repairs to any device in excess of $400
  • Authorization is not required for the first three months rental for a trial period.

    The cost of a device rental may be applied toward the purchase price for the same item supplied by the same provider.

    MHCP expects that people will take reasonable care of AC devices. If a device must be replaced due to a change in medical conditions, loss, theft or irreparable damage, the provider must request authorization for a new device. In the event of theft of a non-dedicated tablet, a police report must be filed for a replacement to be considered.

    List all accessories and options on the device authorization request, even if the individual items do not require authorization.

    Authorization Criteria

    Address all points outlined here for your authorization to be considered:

  • • A description of the current medical status and history
  • • An assessment of the verbal and physical capabilities in relation to need and use of an AC device (electronic and non-electronic)
  • • The speech-language pathologist and occupational therapist or physical therapist assessments may be submitted in a collaborative format as long as the documentation clearly delineates the specific goals and assessment of each therapy discipline
  • • A detailed description of the therapeutic history (physical therapy, occupational therapy, and speech-language pathology), including the nature, frequency and duration of therapeutic services provided to the recipient
  • • Details of the speech-language pathology approaches in relation to the need and use of an AC device
  • • The dates of the trial period of the device as required when the recipient is not currently using a device.
  • • An explicit evaluation of each AC device or method of communication tried by the recipient and information on the effectiveness of each device
  • Address all parameters of device selection, that is, interactive ability in all situational contexts, including:

  • • School
  • • Home
  • • Community
  • • Vocational
  • • Work
  • • Social environments
  • • Detailed description of the recipient's ability to use the proposed device, including speed and accuracy
  • Note: For tablets obtained through a durable medical equipment (DME) supplier, the authorization request must identify the person(s) who will be responsible for locking the tablet and indicate who will be responsible for initial set up and future maintenance of the tablet. An authorization request will be denied if this information is not included.

    Address these situational references dependent upon the mobility level of the recipient:

  • • How will the device be adapted to meet the needs of a recipient who uses a walker?
  • • Is the communication device less obtrusive than other methods when mobility levels are considered?
  • • Frequency of device use in various settings
  • • Empirical data regarding the trial period of use with the device
  • • A description of the level of communication initiation with the selected communication device and whether or not the equipment is used accurately and spontaneously. If the pattern of initiation is different from past history, provide an explanation and justification for the change
  • • A detailed description and plan for the proposed nature, frequency, and duration of therapeutic intervention, including all necessary therapeutic interventions, in relation to the AC device
  • Refer to Authorization for general authorization and documentation requirements, and the MN–ITS Authorization Request User Guide for submitting authorization requests for medical supplies via MN–ITS.

    Refer to the augmentative communication device HCPCS codes when requesting an authorization for purchase or rental. Include the device model name and model number and software, if it applies. In addition, note the following on the authorization request:

  • • List the title of appropriate software applications for electronic tablets supplied through a DME supplier
  • • List all standard and non-standard accessories and options (including mounting systems) on separate lines on the authorization request, even if the individual item does not require authorization
  • • When multiple accessories are requested that are different but use the same code, list each item on a separate line of the authorization request, with appropriate modifiers to distinguish a separate and distinct service or item
  • • Include a description of each item, and model numbers where applicable
  • • List each item by HCPCS code, appropriate modifier, quantity, charges, and medical necessity documentation for non-standard items
  • Authorizations for repairs

    All AC device HCPCS codes have a maximum unit limit of one, according to the National Correct Coding Initiative (NCCI) Medically Unlikely Edit (MUE). Effective immediately, authorizations for repairs must include:

  • • One unit of the AC device code that best represents the device being repaired
  • • The correct repair or replacement modifier (RB)
  • • The device model number
  • • An itemization of the repair service(s) provided (for example, replaced display, replaced touch screen panel, replaced cable) including the provider’s usual and customary amount charged
  • Submit Documentation

    You may submit documents to the medical review agent in one of several ways. Refer to Authorization for details.

    If submitting electronically, complete and submit the following to the Authorization Medical Review Agent:

  • Augmentative Communication Devices and Accessories Authorization Form (DHS-4535) (PDF)
  • • Additional required information such as:
  • • Device name and model number
  • • Type of communication application, if not pre-programmed on the device
  • • All accessories with names and model numbers
  • • Required pricing documents:
  • • Device manufacturer’s – include the Manufacturer’s Suggested Retail Price (MSRP) for the device
  • • DME suppliers – include the invoice (s) for the tablet, software, accessories and labor (identify services)
  • For paper authorization requests, follow direction above, but include a completed MHCP Authorization Form (DHS-4695) (PDF) and fax or mail all documents.

    Pricing documents must:

  • • Include the item manufacturer’s invoice or price quote (actual purchase amount)
  • • Clearly indicate which item on the documentation corresponds to each item on the PA or claim
  • • Have identical code numbers and descriptions on the authorization request and claim
  • Do not modify, alter or change the price list or invoice.

    Do not block out any information on the invoice/price list.

    Order and Delivery

    Dedicated AC devices are supplied through MHCP-enrolled device manufacturers who work with SLPs to obtain documentation, request authorization, and provide training on use of the device.

    Non-dedicated electronic tablets are supplied through an enrolled DME supplier, who will work with the SLP to request authorization and coordinate set-up and delivery to the recipient.

    A non-dedicated tablet warranty begins on the day it leaves a DME supplier’s possession, regardless of the delivery means. A date and signature is required at the time of delivery. MHCP expects that the device be ready for use and delivered to the recipient within a few days.

    To comply with Minnesota Statutes, the device must be locked to become a dedicated AC device. The passcode used to lock the device or application will be noted in the recipient’s records held the by recipient’s speech-language pathologist, the DME supplier or other responsible party as designated by the SLP.

    Augmentative Communication Device Obtained with Alternative Funding*

    Authorizations for ongoing individual speech or language treatment for recipients whose augmentative communication device was purchased with alternate (non-MHCP) funding must be supported with the evaluation of medical appropriateness for the device. The medical appropriateness of the device must be determined before the medical need for ongoing speech or language treatment can be determined. Examples of alternative funding sources include, but are not limited to the following:

  • • Funding through civic groups
  • • Fraternal organizations
  • • Private donations
  • • Private insurance
  • Requests for accessories such as mounting systems for augmentative communication devices obtained with alternative funding must include information on the availability of funding from the same source for the requested accessory.

    Billing

    Refer to the following billing requirements:

  • • Bill using MN–ITS Direct Data Entry claim form 837P Professional or 837I Institutional
  • • Refer to the appropriate MN–ITS User Guide for instructions:
  • Rehabilitative Services (837P) Professional
  • Outpatient Services for Rehab (837I)
  • • X12 Batch users: Refer to Minnesota Uniform Companion Guides and Best Practices for billing instructions
  • • For speech-language pathologists: Only direct time spent with the recipient is billable. Documentation in the patient's records must support the need for face-to-face involvement
  • • Indirect time spent programming, upgrading, modifying or setting up an augmentative communication device or communication and picture book for a recipient is not billable by the SLP.
  • • The cost of shipping, handling, and freight charges are considered all-inclusive in the MHCP payment rate and are not reimbursable. If these charges are included on the invoice or as part of the Manufacturer’s Suggested Retail Price, they will be excluded from the payment.
  • • Do not bill for sales taxes; durable medical items are exempt from taxes for the State of Minnesota. Refer to the Department of Revenue’s Durable Medical Equipment Sales Tax Fact Sheet 117B (PDF) for additional information.
  • • Claims for repairs must include the following:
  • • Appropriate augmentative communication device HCPCS code – one (1) unit
  • • Repair modifier (RB)
  • • U3 modifier, if a tablet
  • • Device model number
  • • Itemized statement describing each element of the repair service
  • • Provider’s usual and customary charge for each element of the repair
  • • Bill professional time spent repairing an AC device with the HCPCS code K0739: “Repair or non-routine service for durable medical equipment requiring the skill of a technician, labor component, per 15 minutes”
  • Dedicated AC Devices from a manufacturer

    Code Description Modifiers

    E2500

    Speech generating device, digitized speech, using pre-recorded messages, less than or equal to eight minutes recording time

    NU, RR, RA, RB

    E2502

    Speech generating device, digitized speech, using prerecorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time

    NU, RR, RA, RB

    E2504

    Speech generating device, digitized speech, using prerecorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time

    NU, RR, RA, RB

    E2506

    Speech generating device, digitized speech, using prerecorded messages, greater than 40 minutes recording time

    NU, RA, RB

    E2508

    Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device

    NU, RR, RA, RB

    E2510

    Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access; for electronic tablets - use U3 modifier

    NU, U3*, RR, RA, RB

    E2512

    Accessory for speech generating device, mounting system

    NU, U3*, RA, RB

    E2599

    Accessory for speech generating device, not otherwise classified

    NU, U3*, RA, RB

    *U3 is required for all tablets, tablet accessories and related services.

    Electronic Tablets as AC Devices from a DME Supplier

    Code Description Modifiers

    E2510

    Speech generating device, including electronic tablets, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access

    NU, U3*, RR, RA, RB

    E2511

    Software applications for electronic tablets

    NU, U3*, RA

    E2512

    Accessory for speech generating device, mounting system

    NU, U3*, RA, RB

    E2599

    Accessory for speech generating device, not otherwise classified

    (Use for all other accessories, including carrying or protective cases)

    NU, U3*, RA, RB

    K0739

    Repair or non-routine service for durable medical equipment per 15 minutes. For tablets - includes technical support by supplier

    NU, U3*, RA, RB

    *U3 is required for all tablets, tablet accessories and related services.

    Provider Reimbursement

    Rates methodologies for AC systems are as follows:

  • • Medical equipment suppliers – Invoice charge plus 20 percent
  • • Manufacturers of AC systems – The manufacturer's suggested retail price (MSRP) minus 20 percent
  • MHCP does not reimburse for:

  • • Freight
  • • Shipping and handling
  • • Tax
  • • Delivery Charges
  • Definitions

    Dedicated – Intended for a specific use or purpose

    Non-dedicated Tablet – For the purpose of this policy, this refers to any electronic tablet designed for multipurpose use and sold (provided) by manufacturers, retailers and suppliers. An examples of this type of tablet is the Apple iPad®. To be covered under MHCP, these tablets must be locked to prevent use other than communication. Once locked, these tablets would be considered “dedicated” and are eligible for coverage.

    Dedicated AC Devices and Tablets – For the purpose of this policy, dedicated AC devices and tablets are those designed, trademarked and supplied by the individual manufacturer.

    References

    Minnesota Statutes 256B.0625 subd. 31, 31a Covered Services; Medical supplies and equipment; Augmentative and alternative communication systems

    Minnesota Statutes 297A.67 subd. 7 General Exemptions; Drugs; medical devices

    Minnesota Rules 9505.5010 – 9505.5030 Prior Authorization Requirements

    Provider Update Electronic Tablets as Augmentative Communication Devices (MES-14-01)

    Durable Medical Equipment Sales Tax Fact Sheet 117B

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