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2012 Texas Medicaid Provider Procedures Manual

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook : 2. Texas Medicaid (Title XIX) Home Health Services : 2.2 Services, Benefits, Limitations and Prior Authorization : 2.2.4 Augmentative Communication Device (ACD) System : 2.2.4.1 ACD System Accessories

2.2.4.1
Accessories are a benefit of Texas Medicaid if the criteria for ACD system prior authorization are met and the medical necessity for each accessory is clearly documented in the speech language pathologist (SLP) evaluation.
All accessories necessary for proper use of an ACD system, including those necessary for the potential growth and expansion of the ACD system (such as a memory card), must be included in the initial prescription/Title XIX form. The following accessories for an ACD system may be covered:
Access devices for an ACD system include, but are not limited to, devices that enable selection of letters, words, or symbols via direct or indirect selection techniques such as optical head pointers, joysticks, and ACD scanning devices.
Mounting systems are devices necessary to place the ACD system, switches and other access devices within the reach of the client. Mounting devices may be considered for reimbursement when used to attach an ACD system or access device to a wheelchair or table.
A request for prior authorization of a wheelchair mounting device must include the manufacturer name, model, and purchase date of the wheelchair. One additional mounting device, separate from the one included in the system, may be considered for prior authorization for the same client.
Providers must use procedure codes E2512 and E2599 when billing for ACD system accessories.
2.2.4.1.1 Carrying Case
Carrying cases may be considered for separate reimbursement with supporting documentation of medical necessity.
Providers must use procedure code E2599 and modifier U1 when billing for the carrying case. Carrying cases are limited to one every three years.
Carrying cases may be considered for prior authorization. The prior authorization request must include the make, model, and purchase date of the ACD system.
2.2.4.1.2 Nonwarranty Repairs
Nonwarranty repairs of an ACD system may be considered for prior authorization using procedure code V5336 with documentation from the manufacturer explaining why the repair is not covered by the warranty.
2.2.4.1.3 Trial Period
In order to ensure the client’s needs are met in the most cost effective manner and to ascertain the most appropriate system and access device for the client, the ACD system is prior authorized for purchase only after the client has completed a three-month trial period that includes experience with the requested system.
The ACD system for the trial period may be obtained through the rental, the school setting, or another setting determined by the licensed SLP.
In the situation where an ACD system is not available for rental and the client has recent documented experience with the requested ACD system, purchase can be considered.
A trial period is not required when replacing an existing ACD system, unless the client’s needs have changed and another ACD system or access device is being considered.
2.2.4.1.4 Rental
Prior authorization may be provided for rental during this trial period. All components necessary for use of the device, such as access devices, mounting devices, and lap trays, must be evaluated during this trial period.
2.2.4.1.5 Purchase
Purchase of an ACD system may be considered for prior authorization when all of the following ACD system criteria are met:
The evaluation/re-evaluation includes documentation that the client has had sufficient experience with the requested ACD system through trial, rental, school, or another setting. When the SLP has confirmed the appropriateness of a specific device for the client, the trial/rental period may be cancelled.
A Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form listing the prescribed ACD system, access device, and accessories (such as a mounting device) must be completed, signed by the physician, and dated.
ACD systems, equipment, and accessories that have been purchased are anticipated to last a minimum of three years.
2.2.4.1.6 Replacement
Prior authorization for replacement may be considered within three years of purchase when one of the following occurs:
Note:
2.2.4.1.7 Software
Computer software that enables a client’s computer or PDA to function as an ACD system may be covered as an ACD system. Providers must use procedure code E2511 when billing for a speech generating software. Requests for ACD software may be considered for prior authorization if the software is more cost effective than an ACD system.
If an ACD system is more cost effective than adapting the client’s computer or PDA, an ACD system may be prior authorized instead of the ACD software.
Laptop or desktop computers, PDAs, or other devices that are not dedicated ACD systems are not a benefit of Texas Medicaid, because they do not meet the definition of DME.

Texas Medicaid & Healthcare Partnership
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