Medicaid: Assistive Technology Services: UNM Center for Development and Disabilities

Guidelines for Submitting AAC Evaluations to Medicaid: Medicaid Form 303

Obtain Medicaid Form 303. A copy is attached for you to copy.
Complete all demographic information.
Leave Procedure Code blank. Under Description, enter "Augmentative Communication Device".
Obtain signature, diagnosis code, and a Prescription for an AAC system from the consumer's primary care physician. Any narrative documentation that the physician provides should be attached.
The claim must be submitted by an ASHA certified and licensed Speech-language pathologist with expertise in Augmentative Communication. The SLP should submit a resume with the claim that has all identifying information, including license number, and synopsis of experience in evaluation and treatment of individuals who use augmentative and alternative communication systems.
Attach the evaluation to the form, sign and date, and submit to the consumer's managed care organization.
Retain copies of all information. Maintain a dated activity log.