Speech Generating Devices (SGD) - Policy Article

Revision Effective Date: 10/01/2024
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Code E2513 to billing information
Added: “Additionally, claims for HCPCS code E2599 must include the supplier price list (PL) amount.” to billing information, as clarification
MODIFIERS:
Added: "E2513" to the HCPCS codes that require KX if all the coverage criteria are met
Added: "E2513" to the HCPCS codes for which claim lines billed without a KX, GA, or GZ modifier will be rejected as missing information
CODING GUIDELINES:
Revised: Information pertaining to methods of device access permitted by E2510, to include "electromyographic sensor" in the indirect selection techniques
Added: Coding guideline information for code E2513


10/17/2024: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Revision Effective Date: 01/01/2020
REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 FED. REG VOL 217):
Revised: “provides” to “provide”
Removed: “The link will be located here once it is available.”
Added: “The required Face-to-Face Encounter and Written Order Prior to Delivery List is available here.” with a hyperlink to the list


04/14/2022: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Revision Effective Date: 01/01/2020
CODING GUIDELINES:
Added: “(PCL)” after reference to “Product Classification List”
Revised: Coding verification review information, to include incorrect coding denial language for products billed using HCPCS that require written coding verification review


03/11/2021: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Revision Effective Date: 01/01/2020
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Removed: REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO 42 CFR 410.38(g) section
REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):
Added: Section and related information based on Final Rule 1713
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS
MODIFIERS:
Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS
CODING GUIDELINES:
Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Revised: Section header “ICD-10 Codes that are Covered” updated to “ICD-10 Codes that Support Medical Necessity”
ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:
Revised: Section header “ICD-10 Codes that are Not Covered” updated to “ICD-10 Codes that DO NOT Support Medical Necessity”


02/27/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

02/14/2019: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This is an article and not a local coverage determination.

Revision Effective Date:  01/01/2017
CODING GUIDELINES:
Added:  Coding Verification Review for E2510


04/05/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.

Revision Effective Date: 01/01/2017
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Removed: Standard Documentation Language
Added: 42 CFR 410.38(g)
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Documentation and billing instructions for E2511-E2599 (previously in the LCD) and Modifier instructions
RELATED LOCAL COVERAGE DOCUMENTS:
Added: LCD-related Standard Documentation Requirements Language Article

Effective July 1, 2016 oversight for DME MAC Articles is the responsibility of CGS Administrators, LLC 18003 and 17013 and Noridian Healthcare Solutions, LLC 19003 and 16013. No other changes have been made to the Articles.

10/16/2015 - Changed title to remove effective date

Revision Effective Date:  07/29/2015 (October 2015 Publication)
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: SGD definitional language from NCD 50.1
Added:  Non-coverage statements from NCD 50.1
CODING GUIDELINES:
Added: Description of HCPCS Code A4601
Added:  Definitions of SGD accessories and examples

Revision Effective Date: 10/31/2014
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Removed: “When required by state law” from ACA new prescription requirements
Revised: Face-to-Face Requirements for treating practitioner