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Speech Generating Devices
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This Aetna clinical policy governs medical necessity, coverage limitations, and coding for speech generating devices and associated accessories for members with severe expressive speech disabilities; it affects providers ordering, evaluating, or supplying SGDs and speech-language pathologists performing evaluations.
Coverage and Medical Necessity Criteria
Evidence summary / background
Evidence summary / background
ALL of the following
- SGDs (speech generating devices) provide synthesized or digitized speech output and may include software that enables laptops, desktops, or PDAs to function as SGDs. Synthesized speech allows independent message formulation rather than playback of pre-recorded messages.
- SGDs may permit multiple methods of message formulation (e.g., letters, words, pictures, symbols) and multiple access methods (e.g., direct touch, indirect selection, specialized access devices such as joysticks, head mice, optical pointers, scanning devices).
- Accessories and upgrades include mounting systems, switches, access devices (optical head pointers, joysticks, scanning devices), memory or software updates, and interface components required to operate the SGD; these should be documented as medically necessary when indicated by the SLP evaluation.
- Assessment of need should be performed by a qualified speech-language pathologist (SLP) with appropriate credentials (e.g., Certificate of Clinical Competence from ASHA). The SLP must evaluate cognitive and language abilities and document functional communication goals, training plan, alternative communication methods considered, and demonstration of the member's ability to use the device and accessories.
- Evidence from small trials and single-subject studies in autism spectrum disorder (ASD) and developmental language delays suggests that SGDs can increase communication acts, requesting behaviors, reciprocity, and peer engagement in some children, particularly when combined with peer-mediated or structured instructional approaches; however, study limitations (small sample sizes, heterogeneous participants, varied baselines, and potential confounds) limit generalizability.
- Randomized and comparative studies indicate both high-tech (SGD) and low-tech (PECS) augmentative and alternative communication approaches can produce significant improvements in functional communication, with no consistent advantage for one modality across all participants; individualized assessment is essential.
- Use of SGDs is generally considered after other treatments and, for acquired disorders (eg, stroke, head trauma), is typically not initiated less than 4 to 6 months post-injury to allow for potential spontaneous recovery.
- Non-covered items and limitations: Internet/phone services, home modifications to support SGD use, and hardware/software features not directly necessary for generation of audible/verbal speech, email, text, or phone messages (eg, document creation, games, music, video conferencing) are not covered. Desktop/laptop computers, tablets, smartphones, and other non-dedicated devices are not covered as DME because they have substantial non-medical utility.
- SGDs with multiple interfaces or multiple access methods are generally not considered medically necessary unless the clinical record clearly documents the need for multiple interfaces or access methods for the individual member.
- Multi-lingual modules for SGDs are considered not medically necessary. Only one SGD or speech-generating software program is considered medically necessary per member at a time.
Coding and Timing
| 92521 | Evaluation of speech fluency (eg, stuttering, cluttering) |
| 92522 | Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria) |
| 92523 | Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) |
| 92524 | Behavioral and qualitative analysis of voice and resonance |
| 92607 | Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour |
| 92608 | Each additional 30 minutes |
| 92609 | Therapeutic services for the use of speech-generating device, including programming and modification |
| E2500 | Speech generating device, digitized speech, using pre-recorded messages, ≤ 8 minutes recording time |
| E2502 | Speech generating device, digitized speech, >8 minutes to ≤20 minutes recording time |
| E2504 | Speech generating device, digitized speech, >20 minutes to ≤40 minutes recording time |
| E2506 | Speech generating device, digitized speech, >40 minutes recording time |
| E2508 | Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device |
| E2510 | Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access |
| E2511 | Speech generating software program, for personal computer or personal digital assistant |
| E2512 | Accessory for speech generating device, mounting system |
| E2599 | Accessory for speech generating device, not otherwise classified |
| G0153 | Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes |
| F80.0 - F80.9 | Specific developmental disorders of speech and language |
| I69.020 - I69.028, I69.120 - I69.128, I69.220 - I69.228, I69.320 - I69.328, I69.820 - I69.828, I69.920 - I69.928 | Speech and language deficits following cerebrovascular disease |
| R47.01 - R47.9 | Speech disturbances, not elsewhere classified |
Provider Responsibilities, Prior Authorization, and Documentation
Prior Authorization Determined by Plan
Prior authorization is determined by the member's plan. Clinical Policy Bulletins (CPBs) such as this one are intended to assist in administering plan benefits and do not replace plan-specific authorization rules; providers must check the member’s benefit plan for any prior authorization requirements before ordering an SGD.
- Providers should verify prior authorization requirements with the payer and document authorization numbers when required.
Required SLP Evaluation and Documentation
A formal, written SLP evaluation and recommendation must be completed and forwarded to the member’s treating physician prior to ordering the device. The evaluation must document: functional communication goals and treatment options; a device-specific training schedule; assessment of whether daily communication needs can be met with natural methods; demonstration of the member’s cognitive and physical ability to use the device; evaluation of type/severity/language/cognitive status and expected course; rationale for device and accessory selection; and for upgrades, the functional benefit compared to the prior device. The SLP performing the evaluation must not be employed by or have a financial relationship with the SGD supplier.
Emphasize Individualized Clinical Documentation
Clinical studies and case reports emphasize the need to document individual cognitive, speech and language skills, device programming and vocabulary adjustments, and other individual characteristics that may predict communication outcomes. Detailed documentation supports medical necessity determinations and helps identify which patients are likely to benefit from SGDs.
Comparative Trial Findings
A randomized pilot trial comparing high-tech SGDs to low-tech AAC (PECS) reported significant improvements with both approaches and found no significant difference between them. This highlights that high-tech devices may be appropriate for some patients, but outcomes can be similar to low-tech options; device selection should be individualized and justified in the SLP evaluation.
Non-Covered Services and Nonessential Features
Certain services and features are not covered. Internet or phone services and modifications to a member’s home to accommodate SGD use are not covered. Features or hardware/software not necessary for generation of audible/verbal speech, email, text, or phone messages (for example, document/spreadsheet creation, games, music, or general-purpose computing, and video conferencing) are not considered medically necessary.
- Home internet or phone service modifications — not covered
- Device features not used to meet functional speaking needs (e.g., gaming, general computing) — not covered
Authorization, Coding, and Step-Therapy Notes
This document does not specify a step therapy protocol or required ordering/coding authorization workflow. CPT/HCPCS codes listed are covered only if selection criteria are met; however, individual plans may impose prior authorization, coding or coverage limits. Providers must check member benefits for any additional coding, prior authorization, or utilization management requirements.
- CPT/HCPCS codes in the CPB are covered only when the policy’s selection criteria are met
- No step therapy protocol is defined in this CPB; follow plan-specific processes
Key Definitions
Background and Clinical Evidence
Speech-generating devices (SGDs), also called augmentative and alternative communication devices, produce audible/verbal speech for individuals with severe expressive speech impairments (for example, anarthria, aphasia, apraxia, dysarthria). SGDs may use digitized (prerecorded whole-message output) or synthesized (text-to-speech) output and can be dedicated hardware or speech-generating software that enables a computer or PDA to function as an SGD. SGDs commonly include access devices (for example, optical head pointers, joysticks, scanning devices, head control mice) and mounting systems to enable use by persons with neurologic or motor limitations; assessment and device selection should be performed by a qualified speech-language pathologist.
References, Review Dates, and Administrative Notes
The policy references multiple clinical studies, reviews and guidance (including single-subject designs and small randomized or pilot studies) regarding use of SGDs across populations. However, the document does not specify a formal step therapy protocol. Decisions about sequencing of low- versus high-technology interventions and timing of device initiation (for acquired disorders the policy notes a typical delay of 4–6 months before initiating an SGD) should be informed by the cited literature and by individualized clinical assessment.
Administrative notes: this Clinical Policy Bulletin provides a summary of coverage criteria and referenced evidence to assist in benefit administration. It is not a contract and does not replace plan-specific provisions; prior authorization requirements and coverage determinations are made according to the member’s plan and program rules.
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