Key facts for NCD 50.1
- Benefit category
- Durable Medical Equipment
- Effective date
- 07/29/2015
- Implemented 09/21/2015
- Transmittal
- Transmittal 184
- Versions published
- 2
- Manual chapter
- 50
- NCD Manual (Pub. 100-03)
TL;DR
NCD 50.1 sets Medicare's national policy for speech generating devices under the benefit category "Durable Medical Equipment", effective 07/29/2015 and implemented 09/21/2015. Internet or phone services or any modification to a patient’s home to allow use of the speech generating device are not covered by Medicare because such services or modifications could be used for non-medical equipment such as standard phones or personal… It has been revised 1 time since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
A. General
Speech generating devices are considered to fall within the durable medical equipment (DME) benefit category established by §1861(n) of the Social Security Act. They are covered for patients who suffer from a severe speech impairment and have a medical condition that warrants the use of a device based on the following definitions.
Speech generating devices are defined as durable medical equipment that provides an individual who has a severe speech impairment with the ability to meet his or her functional, speaking needs. Speech generating devices are speech aids consisting of devices or software that generate speech and are used solely by the individual who has a severe speech impairment. The speech is generated using one of the following methods:
• digitized audible/verbal speech output, using prerecorded messages;
• synthesized audible/verbal speech output which requires message formulation by spelling and device access by physical contact with the device-direct selection techniques;
• synthesized audible/verbal speech output which permits multiple methods of message formulation and multiple methods of device access; or
• software that allows a computer or other electronic device to generate audible/verbal speech.
Other covered features of the device include the capability to generate email, text, or phone messages to allow the patient to “speak” or communicate remotely, as well as the capability to download updates to the covered features of the device from the manufacturer or supplier of the device.
If a speech generating device is limited to use by a patient with a severe speech impairment and is primarily used for the purpose of generating speech, it is not necessary for the device to be dedicated only to audible/verbal speech output to be considered DME. Computers and tablets are generally not considered DME because they are useful in the absence of an illness or injury.
Indications and limitations of coverage
B. Nationally Covered Indications
N/A
C. Nationally Non-Covered Indications
Internet or phone services or any modification to a patient’s home to allow use of the speech generating device are not covered by Medicare because such services or modifications could be used for non-medical equipment such as standard phones or personal computers. In addition, specific features of a speech generating device that are not used by the individual who has a severe speech impairment to meet his or her functional speaking needs are not covered. This would include any computing hardware or software not necessary to allow for generation of audible/verbal speech, email, text or phone messages, such as hardware or software used to create documents and spreadsheets or play games or music, and any other function a computer can perform that is not directly related to meeting the functional speaking communication needs of the patient, including video communications or conferencing. These features of a speech generating device do not fall within the scope of § 1861(n) of the Social Security Act and the cost of these features are the responsibility of the beneficiary. Suppliers of speech generating devices are encouraged to furnish the beneficiary with a voluntary Advance Beneficiary Notice (ABN), or similar notice, which informs that these features are not covered and to alert the beneficiary of the expense of these features.
D. Other
A/B MACs acting within their respective jurisdictions have discretion to cover or not cover speech generating devices based on their individual reasonable and necessary determinations.
(This NCD last reviewed July 2015.)
Text reproduced from the CMS Medicare Coverage Database record for NCD 50.1 version 2. View the original on cms.gov.
Revision history
08/2015 - This Change Request (CR) provides updates to add a revised scope of benefit national coverage determination for speech generating devices (SGDs) covered under the Medicare benefit category for Durable Medical Equipment (DME). Implementation date: 09/21/2015 Effective date: 07/29/2015 ( TN 184 )(CR9281)
09/2002 - Corrected section to include material that was inadvertently deleted via transmittal 150. Effective date NA. ( TN 158 ) (No change request number.)
11/2000 - Added new section, and defined speech generating devices. Effective and implementation dates January 1, 2001. ( TN 132 ) (CR 1328)
How this NCD shows up on remittances
A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.
How QuickIntell applies NCD 50.1
QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.
Frequently asked questions — NCD 50.1
What does NCD 50.1 cover?
Internet or phone services or any modification to a patient’s home to allow use of the speech generating device are not covered by Medicare because such services or modifications could be used for non-medical equipment such as standard phones or personal computers. In addition, specific features of a speech generating device that are not used by the individual who has a severe speech impairment to meet his or her… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 50.1 take effect?
The current version (2) is effective 07/29/2015, implemented 09/21/2015, published in transmittal 184. CMS lists 2 versions of this NCD.
Does a Local Coverage Determination override NCD 50.1?
No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database NCDs via the CMS Coverage APIVersion API snapshot 2026-09-27 · effective 2026-09-20 · file national-coverage-ncd.jsonSHA-256 a90fadfd264b9ef4…
Disclaimer
This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.