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.