Does Medicare Cover Speech Generating Devices?
This article was updated on: 09/12/2018
If you have a severe speech impairment, your doctor or speech therapist may recommend speech generating devices to treat your condition. If you are covered by Medicare, the device may be covered if you meet certain conditions. Read on to learn more about Medicare coverage of speech generating devices.
What are speech generating devices?
There are many kinds of speech generating devices available. Some are simple devices that can record and play messages to allow people to communicate by pressing a button to play a particular message, while others use a specially equipped iPad and speech-generating apps to allow more complex forms of message formation and communication. In some cases, speech generating devices are software packages that can be installed on a dedicated computer or laptop and generate speech for the user using input from a stencil or even eye-movements.
Who can get speech generating devices?
In the medical community, severe speech impairment is sometimes called “apraxia.” The American Speech-Language and Hearing Association (ASHA) defines apraxia as a speech disorder in which the signals from the brain that control speech are interrupted, making the person unable to move his mouth and tongue to make speech.
Apraxia is caused by brain damage, most often as a result of a stroke, although the damage can also be caused by traumatic brain injury, dementia, brain tumor, or other neurological disorders. Apraxia is often accompanied by other speech and language disorders, such as aphasia, which is a language difficulty also caused by damage to the brain.
A person with apraxia may have one or more of the following symptoms or signs according to ASHA:
- Trouble making speech sounds.
- Speech errors such as substituting one word for another, distorted speech sounds, and omitted words.
- “Groping” with the tongue and lips when trying to form certain sounds.
- Slow speech.
- Trouble with “purposeful” speech, where thought is required before speaking, as opposed to “automatic” speech, such as a greeting.
- Being unable to make any sounds at all in the most severe cases.
Apraxia treatment may include speech-language therapy and exercises to coordinate the muscles used in speech.
However, in the most severe cases, or if traditional therapy is unsuccessful, ASHA suggests that speech generating devices may be necessary to help the person communicate.
Does Medicare cover speech generating devices?
In 2015, Medicare moved to cover speech generating devices for individuals who meet all the following conditions:
- A speech-language pathologist must evaluate you and issue a written assessment that includes a description of the speech impairment, why speech generating devices are the best treatment choice, why a specific device is recommended, and the training schedule to teach you how to use the device.
- Your medical condition must cause a severe speech impairment that can only be effectively treated by speech generating devices; all other options have been ruled out as a treatment.
- Your health care provider believes that your speech impairment will significantly improve if you use speech generating devices.
- Your doctor orders the device after receiving the speech-language pathologist’s written evaluation.
- The Speech-Language Pathologist can’t be an employee or have a financial relationship with the supplier of the speech generating device.
For Medicare purposes, speech generating devices are considered durable medical equipment, or DME. Under Medicare’s rules for coverage of DME, the device must be solely for the use of the Medicare beneficiary, withstand repeated use, and have an expected life of at least three years. Speech generating devices also include software that allows a laptop computer, desktop computer or personal digital assistant (PDA) to function as a speech generating device.
If you meet all the criteria for Medicare coverage of speech generating devices, Part B generally pays 80% of the allowable charges for the device. You are responsible for your 20% coinsurance amount plus any applicable Part B deductible.
In addition, both your doctor and the company providing speech generating devices must be enrolled in Medicare in order for the device to be covered. Be sure to ask if your DME provider participates in Medicare, too, because participating providers must accept Medicare assignment, which limits the amount you can be charged for the device. If your DME supplier does not accept assignment, you can be charged an amount significantly more than what Medicare allows.
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