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Excellus BlueCross BlueShieldCommercial · Coverage · Durable Medical Equipment & Supplies · NY · Speech Therapy, Pediatrics, Occupational TherapyMedium impact

Augmentative and Alternative Communication Systems (e.g., Speech-generating Devices) 1.01.03

Effective date
Aug 20, 2026
Identified
Jun 20, 2026

Summary

Effective August 20, 2026, augmentative and alternative communication devices, including speech generating devices, are considered medically appropriate when all criteria are met. The criteria include a formal evaluation by a speech-language pathologist that documents the communication impairment, a technological assessment, functional goals, a training plan, and a request for a minimum one-month trial with documented effectiveness. Documentation from an appropriate health professional must show the patient has the cognitive and physical abilities to use the device, the device must be expected to benefit the patient's speech disability, and the device must not have been selected primarily for the convenience of the patient, family, or providers. Replacement of properly functioning devices is considered not medically necessary. The 2025 annual review updated the DME repair and replacement statements, and the 2026 annual review left the policy intent unchanged.

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What to do

Action · 10 steps
01Already effective August 20, 2026: Claims for speech generating devices need a formal written evaluation by a speech-language pathologist with training and experience with SGDs.
02That evaluation must include the communication impairment, a technological assessment of whether basic needs could be met with a more basic device, functional goals with the rationale for the device and accessories, a treatment plan with training in the environment where the device will be used, a request for a minimum one-month trial with reevaluation at the end, documented effectiveness, and the history of AAC or SGD use in every environment.
03Claims need documentation from an appropriate health professional, such as an occupational therapist, psychologist, or developmental pediatrician, that the patient has the cognitive and physical abilities to use the device.
04A high-tech device request needs documentation that an alternative communication device or system failed to meet the patient's basic communication needs.
05Each accessory needs its medical necessity documented in the formal evaluation.
06The evaluating SLP must not have a financial relationship with or be an employee of the device supplier.
07Initial coverage is limited to one month when no trial period is documented, and continuation needs the referring provider's documentation of meaningful improvement during the trial.
08For pre-school or school-age children, an IEP should be completed through the school district before the request is submitted.
09For New York State Managed Medicaid members, medical necessity is reviewed per the eMedNY DME provider manual.
10Repair of equipment damaged by patient neglect, theft, or abuse, or when another available coverage source is an option, is ineligible for coverage.

Codes mentioned

92597926059261892606926079260892609E1902E2351E2500E2502E2504E2506E2508E2510E2511E2512E2599E3000

Original notice

Augmentative and Alternative Communication Systems (e.g., Speech-generating Devices) 1.01.03
excellusbcbs.com · Always check the source before changing claims.
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Related policy hubs

Excellus BlueCross BlueShield policiesNY policy changesSpeech TherapyPediatricsOccupational TherapyCode 92597Code 92605Code 92618Code 92606Code 92607Code 92608Code 92609Code E1902Code E2351Code E2500Code E2502Code E2504Code E2506Code E2508Code E2510Code E2511Code E2512Code E2599Code E3000

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