Introduction

Getting an AAC device covered by insurance has historically been one of the most frustrating parts of the process. Complex documentation, inconsistent criteria, long wait times, and unexplained denials. In 2025, several developments have shifted the landscape — not enough to make the process easy, but enough to make success more likely if you know where to look.

CMS Clarification on DME Coverage

The Centers for Medicare and Medicaid Services released updated guidance this year clarifying that speech-generating devices (SGDs), including eye gaze AAC devices, qualify as covered Durable Medical Equipment when medical necessity is properly documented. The key phrase is ‘properly documented.’ What CMS now makes clearer is what that documentation needs to include: a diagnosis that explains the communication impairment, a statement from a physician or SLP, evidence that the device is the appropriate solution, and confirmation that the user cannot express their needs through natural speech or gestures alone.

What Has Not Changed

Prior authorization is still required for most commercial plans and Medicaid programs. The evaluation must be conducted by a certified SLP — ideally one with AAC specialization. And the process still takes time, typically four to twelve weeks from initial evaluation to device delivery, even when everything goes smoothly.

New Appeals Leverage

The updated CMS guidance also gives families new leverage in appeals. If a commercial insurer denies coverage, the argument that the device meets CMS medical necessity criteria — the federal standard — is now stronger. Several advocacy organizations have published model appeal letter templates based on the new guidance. We have linked to these in our Resources section at eyetechds.com.

State-by-State Variation

Medicaid is administered at the state level, which means coverage rules vary. Some states have moved toward more streamlined AAC approval processes; others remain difficult to navigate. Your state’s Assistive Technology Program (every state has one, funded federally) is a free resource for navigating local coverage rules. They can advise on documentation, connect you with SLPs familiar with the process, and sometimes provide device loans during the waiting period.