Summary & Overview
CPT 92607: Evaluation for Speech‑Generating Device, First Hour
CPT code 92607 covers the provider evaluation for prescription of a speech‑generating device and represents the first or only hour of that assessment. The code matters nationally because it documents a specialized, multidisciplinary evaluation that determines patient eligibility for Augmentative and Alternative Communication (AAC) technology and supports medical necessity for device coverage. Proper coding of this service affects access to communication aids for patients with severe speech impairment and influences payer medical review and reimbursement pathways.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and common modifiers affecting claim processing. The publication outlines benchmarks for utilization, common reasons for claim denials, and recent policy updates or payer guidance relevant to AAC evaluations. It also summarizes documentation elements typically required in the detailed report produced during the evaluation.
This summary is intended for clinicians, billing staff, and policy analysts seeking a national perspective on coding and coverage considerations for speech‑generating device evaluations under CPT code 92607.
Billing Code Overview
CPT code 92607 describes the provider evaluation for prescription of a speech‑generating device. This service represents the first or only hour of the evaluation, during which the provider interacts with the patient, conducts assessments of communication ability, and prepares a detailed report on the patient’s functional communication skills and recommended techniques or devices.
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Service type: Speech‑generating device evaluation
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Typical site of service: Outpatient clinic or specialized speech‑language pathology setting
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45-year-old with severe expressive aphasia following an ischemic stroke who cannot reliably produce intelligible speech and is being evaluated for a speech-generating device (SGD). The patient is referred by a neurologist or speech-language pathologist (SLP) to a physician or qualified clinician trained in augmentative and alternative communication (AAC) device prescription. The clinical workflow begins with a medical and communication history review, observation of the patient’s natural communication attempts, and standardized tests of language, cognition, oral motor control, and vision. The provider evaluates the patient’s ability to access and operate various SGD access methods (touchscreen, single or multi-switch scanning, head or eye gaze), trials appropriate devices and software, documents device selection rationale, and trains the patient and caregivers on use. The encounter includes written recommendations and a detailed report addressing prognosis, communication goals, device settings, required accessories, and follow-up plans to support durable medical equipment (DME) coverage and a prescription for the SGD.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the professional component of a service is billed separately. |
59 |