When it comes to funding and AAC, there are many components that go into the process! Use this week's blog post as a reference for answering many of the FAQs related to funding and AAC.
Question: Is low-tech AAC covered by insurance?
Low-tech AAC systems, such as communication boards or picture books, are usually created by the AAC user's treating SLP.
Funding sources typically do not cover non-speech-generating devices.
Question: What paperwork is required to get a user a device funded?
There are different forms, documentation, and processes required for each and every insurer. You can find the funding forms required for your state here: Funding Forms
If you are new to AAC assessment and funding, reach out to your local Forbes AAC Assistive Technology Specialist (ATS) or contact our funding department directly!
Use this link to find your ATS: Find an Assistive Technology Specialist
Question: What is a CMN?
A CMN is a Certificate of Medical Necessity.
The Centers for Medicare & Medicaid Services (CMS) and some state Medicaids require the beneficiary (the AAC user) to have a face-to-face examination with their physician less than 6 months prior to the written order for a Speech Generating Device (SGD).
The physician MUST document that the beneficiary was evaluated and/or treated for a condition that supports the recommendation for a SGD. This documentation must be provided along with the CMN.
Question: What if a user has a primary and a secondary insurer?
Primary insurance is the first funding source that must be used to secure funding. The evaluation must be submitted through the primary insurance first!
The secondary coverage source is utilized when an authorization or claim is denied or only partial funding has been secured from the primary insurance.
Remember, for pediatric patients, Medicaid is always the payer of last resort.
Question: Will my insurance cover an AAC app on my personal tablet or iPad?
No, tablets, apps, and computers are considered nondurable, nondedicated devices.
Question: What are the relevant CPT codes to use with AAC evaluation and treatment?
The use of 92607 is used for evaluation for prescription for speech-generating augmentative and alternative device and the use of 92609 is used for therapeutic services for the use of speech-generating device (including programming and modification).
What’s the difference between 92507 and 92609? The use of 92507 should be when speech language treatment is being provided while 92609 should be used when you are working with the AAC user on use of the device itself or if you are modifying/programming it for their use.
Take a look at our Quick Guide to Billing for AAC resource to learn more!
Forbes AAC recently launched our Funding Portal!
Learn more about it here: Forbes AAC Funding Portal
Create an account here: Funding Portal Login
You can initiate the funding process by submitting a funding packet to our funding team (funding@forbesaac.com) or by directly contacting your Assistive Technology Specialist (Find an Assistive Technology Specialist).
That packet is then added to our database and is displayed on the Funding Portal!
There you can check the status of the submission, check the progress of the submission, and add any missing documentation that is required to move forward.
You can also download and complete relevant documents through the portal!
Track the step-by-step progress of each user's funding packet as we work with the insurance providers.
For parents or caregiver, you can also create an account on the Funding Portal!
Create an account here: Funding Portal Login
Then you can verify that all the required documents for funding have been received as well as follow the progress of the funding packet.
Reach out to your local Assistive Technology Specialist with any questions related to funding and the Funding Portal!
References:
American Speech-Language-Hearing Association (n.d.). Augmentative and Alternative Communication (Practice Portal). www.asha.org/Practice-Portal/Professional-Issues/Augmentative-and-Alternative-Communication/
Beukelman, D. R., & Light, J. C. (2020). Augmentative & alternative communication: Supporting children and adults with complex communication needs (5th ed.). Brookes.
Katie Threlkeld, M.S., CCC-SLP is a licensed, ASHA-certified speech-language pathologist and the Educational Program Developer at Forbes AAC. She has over eight years of experience in AT and AAC assessment and treatment with both the pediatric and adult populations. Katie has presented at the state and national level on AAC topics and she has University teaching experience at the undergraduate and graduate level.