A change in Medicare reimbursement for a prosthetic device that allows people who have had their voice box removed to speak has led some providers to stop offering the device or reducing the number of patients they see. The change has to do with how Medicare reimburses for a device called tracheo-esophageal voice prosthesis, or TEP. The device facilitates speech for laryngectomy patients who have had surgery to remove their voice box, usually because of cancer. It must be replaced roughly two to four times a year. In the past, Medicare partially reimbursed patients who purchased TEP devices at full price from the manufacturer before having them inserted by a doctor. Now, since Oct. 1, Medicare covers only devices that have been purchased by healthcare providers. Providers say the problem is that the amount Medicare reimburses them per device is far less than the invoice price they pay.