Altered Auditory Feedback Devices for Speech Dysfluency (Stuttering)
Customize your policy alerts
Sign up for select_health Policy CCP.1188 alerts
Get alerted when Policy CCP.1188 changes without checking for updates manually.
Monitor payer policy activity
This policy addresses coverage for altered auditory feedback (anti-stuttering) devices used to treat speech dysfluency (stuttering) and applies to Select Health of South Carolina medical benefit determinations.
No material clinical or coverage changes in this revision.
Coverage Determination
Not medically necessary
Policy determination
Insufficient evidence for clinical effectiveness and durability; studies are small, short-term, uncontrolled or at risk of bias; randomized evidence does not show significant benefit over comparator treatments.
The evidence base does not support routine use of altered auditory feedback devices to treat stuttering. Systematic reviews and primary studies are limited by small sample sizes, short follow-up, incomplete reporting, and uncontrolled or otherwise biased designs, which restrict generalizability. Randomized evidence (the Ritto trial) and pooled analyses have not demonstrated clear benefit over comparator treatments, and important questions remain about effect during conversational speech, durability of response, appropriate device settings for individuals, and which patients — if any — are likely to benefit.
Altered auditory feedback devices (also called antistammering devices) for the treatment of speech dysfluency (stuttering) are considered investigational and not medically necessary. This determination is based on insufficient and low-quality evidence showing durable, generalizable clinical benefit in everyday speaking situations; randomized and comparative data do not demonstrate consistent improvements in communication or psychosocial functioning compared with established therapies.
Coding and Regulatory
Provider Actions and Billing Guidance
Prior authorization required; codes 92609 and E1399 affected
Devices commonly billed with CPT code 92609 and HCPCS code E1399 are considered investigational and not medically necessary for treatment of speech dysfluency (stuttering). Prior authorization should follow the plan's routine processes for investigational items; claims submitted with these codes are subject to medical review and potential denial under this policy.
Offer behavioral/speech therapy as alternative covered services
Behavioral therapy and speech therapy for neurogenic stuttering are identified as alternative, covered services and should be considered before devices addressed by this policy.
- Consider referral for behavioral therapy.
- Consider referral for speech therapy for neurogenic stuttering.
Evidence search methods and sources (search date May 11, 2026)
Evidence sources and search strategy used to inform this policy are documented: searches of PubMed, Cochrane Library, U.K. NHS CRD, AHRQ, and CMS were performed using terms including 'stuttering', 'feedback, sensory', 'altered auditory feedback', 'delayed auditory feedback', and 'electronic fluency device' on May 11, 2026.
- Databases searched: PubMed; Cochrane Library; U.K. NHS Centre for Reviews and Dissemination; AHRQ; CMS
- Search date: May 11, 2026
- Search terms: 'stuttering' (MeSH), 'feedback, sensory' (MeSH), 'altered auditory feedback', 'delayed auditory feedback', 'electronic fluency device'
Denial risk for altered auditory feedback devices (investigational/not medically necessary)
Because altered auditory feedback devices are investigational and not clinically proven for stuttering, claims for these devices are not covered and may be denied; providers should anticipate denial if billing with affected codes.
- Denial rationale: devices are investigational/not medically necessary for speech dysfluency (stuttering).
- Operational note: claims submitted for these devices are subject to denial per policy CCP.1188.
Background
Stuttering (speech dysfluency) is characterized by involuntary disruptions in the flow of speech such as repetitions of sounds or syllables, prolongations, and blocks; these core features may be accompanied by secondary behaviors (for example, facial or body movements) and social or functional impacts such as avoidance. Stuttering occurs across the lifespan but is most commonly developmental in children. Assessment typically relies on clinical observation, patient or caregiver interview, and standardized testing to determine type, severity, and appropriate therapy needs.
Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.