FUNDING DIRECTORY
Documentation Requirements & Forms
 Where do I begin?
Medicare criteria for Speech Generating Devices
Where to send completed forms
Locate your ZYGO equipment health plan provider in your state
Rental Program Information
Funding FAQ
Glossary of terms
AAC and Funding Resources
ZYGO AAC Devices and HCPCS Allowables

SUBMIT CLAIMS FOR EQUIPMENT
Client Profile
Assignment of Benefits
Consent Form
Sample Evaluations
Physician’s Prescription
Sample Speech Therapists Evaluation

 MEDICARE CRITERIA
Speech Generating Device Funding A speech generating device or accessory in Medicare HCPC code categories E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512, or E2599 is covered when all of the following criteria (1-7) are met:

1) Prior to the delivery of the SGD, the patient has had a formal evaluation of their cognitive and communication abilities by a credentialed speech-language pathologist (SLP). The formal, written evaluation must include, at a MINIMUM, the following elements:
  • Current communication impairment, including the type, severity, language skills, cognitive ability, and anticipated course of the impairment;
  • An assessment of whether the individual’s daily communication needs could be met using other natural modes of communication;
  • A description of the functional communication goals expected to be achieved and treatment options;
  • Rationale for selection of a specific device and any accessories;
  • Demonstration that the patient possesses a treatment plan that includes a training schedule for the selected device;
  • The cognitive and physical abilities to effectively use the selected device and any accessories to communicate;
  • For a subsequent upgrade to a previously issued SGD, information regarding the functional benefit to the patient of the upgrade compared to the initially provided SGD;

2) The patient’s medical condition is one resulting in a severe expressive speech impairment; and,

3) The patient’s speaking needs cannot be met using natural communication methods; and,

4) Other forms of treatment have been considered and ruled out; and,

5) The patient’s speech impairment will benefit from the device ordered; and,

6) A copy of the SLP’s written evaluation and recommendation have been forwarded to the patient’s treating physician prior to ordering the device; and,

7) The SLP performing the patient evaluation may not be an employee of or have a financial relationship with the supplier of the SGD.

If one or more of the SGD coverage criteria 1-7 is not met, the SGD will be denied as not medically necessary.