This guide describes a general process for considering augmentative and alternative communication (AAC). It is not a prescription, a device recommendation, or a guarantee of insurance or school funding. The person who communicates should participate in decisions to the greatest extent possible.
Start with communication, not equipment
AAC includes unaided communication, such as facial expression and gesture, and aided communication, such as paper boards, symbol displays, spelling, apps, and speech-generating devices. A person may use several methods. AAC can supplement speech or provide an alternative when speech is not reliable enough for every situation.
There are no cognitive, behavioral, motor, or age prerequisites for considering AAC. Assessment should identify supports that make communication possible instead of requiring the person to prove readiness without those supports. ASHA's AAC Practice Portal describes AAC assessment as an ongoing, collaborative process.
1. Identify priorities and current communication
Begin with the person's goals, communication partners, environments, languages, culture, literacy, existing signals, and access needs. Document what already works and where communication breaks down.
- How does the person express choice, refusal, consent, pain, connection, questions, and urgent needs?
- Which partners understand those signals, and in which settings?
- When do fatigue, positioning, sensory conditions, motor changes, or time pressure affect access?
- What does the person want communication to make easier or more independent?
2. Complete a collaborative assessment
An appropriately qualified speech-language pathologist commonly coordinates AAC assessment. The team may also include the AAC user, family or chosen supporters, educators, occupational and physical therapists, vision and hearing professionals, rehabilitation engineers, medical clinicians, interpreters, and the funding supplier.
Assessment should combine observation, interviews, supported participation, language and literacy assessment, and trials. Standardized scores alone rarely capture communication across real environments. Relevant areas can include:
- Receptive and expressive communication across all current modes.
- Vision, hearing, sensory access, motor control, posture, and fatigue.
- Direct selection, eye gaze, head pointing, switches, scanning, and partner-assisted access.
- Vocabulary, symbol representation, spelling, language organization, and output.
- Portability, mounting, durability, charging, privacy, maintenance, and backup communication.
- Communication partner knowledge and environmental barriers.
3. Match features to the person
Feature matching compares the person's needs with system characteristics. It should not begin with a preferred brand. Consider the range of communication functions, access method, display, vocabulary, language support, voice and output options, portability, mounting, durability, customization, repair support, and total cost.
Selection must reflect the person's preferences. The fastest option in a clinic may not be the most reliable option at home, school, work, healthcare visits, or in the community.
4. Trial realistic options
Trial more than one reasonable option when possible. There is no universal trial length. The trial should be long enough to observe learning and use across meaningful settings without delaying access unnecessarily.
Before a trial, agree on what will be observed. Useful evidence may include whether the person can communicate personally important messages, initiate and respond, repair misunderstandings, use the system with different partners, and tolerate the access demands. Record barriers and the support provided; unsupported performance is not a fair test of a new system.
Maintain a reliable low-tech or familiar backup throughout assessment and after a device is selected.
5. Document the recommendation
The report should connect each recommended feature to an assessed functional need and summarize the options tried, the person's preferences, trial evidence, access method, required accessories, partner supports, and implementation plan. Funding requirements vary by payer, program, age, setting, and jurisdiction; verify the current rules before submission.
For US Medicare beneficiaries, speech-generating devices can fall within the durable medical equipment benefit when current coverage requirements are met. Medicare distinguishes covered speech and communication functions from general computing features, and local contractors make reasonable-and-necessary determinations. Use the current CMS National Coverage Determination 50.1 for benefit-category and coverage principles, and the companion SGD Policy Article A52469 for coding, accessory, and documentation detail that contractors apply—verify both in the Medicare Coverage Database rather than relying on a fixed checklist here.
6. Plan for access while funding is pending
Funding and procurement can take time. The team should identify interim communication, loan equipment where available, and a way to report changes that affect the recommendation. A denial is not clinical evidence that AAC is unnecessary. Appeal or alternative-funding decisions depend on the specific program and should use current guidance.
7. Implement the whole communication system
Delivery of equipment is the beginning of implementation, not the endpoint. Confirm safe positioning and mounting, customize meaningful vocabulary with the AAC user, and establish access in every important setting. Communication partners need practical training in modelling, waiting, responding to all communication modes, and repairing breakdowns without taking control of the person's message.
The person should retain access to AAC throughout the day. Removing a communication system as punishment or requiring spoken words before honoring an AAC message undermines communication access.
8. Follow up and revise
Review the system after delivery and whenever communication, vision, hearing, motor access, health, environment, vocabulary, or personal priorities change. Follow-up should address:
- Whether the system remains available, charged, positioned, and operational.
- Whether vocabulary supports the person's current life and relationships.
- Whether partners respond consistently and respect messages.
- Whether access is efficient and sustainable across the day.
- Whether repair, replacement, training, or a new assessment is needed.
Minimum handoff checklist
- The AAC user participated in selection and vocabulary decisions.
- The recommendation is linked to functional communication needs and trial evidence.
- Primary and backup communication are available.
- Access, positioning, mounting, and sensory needs are documented.
- Key partners know how to support use without speaking for the person.
- Funding requirements and responsible contacts are recorded.
- Follow-up, repair, and reassessment plans have named owners.
Sources
- American Speech-Language-Hearing Association. Augmentative and Alternative Communication Practice Portal. Accessed July 21, 2026.
- American Speech-Language-Hearing Association. Augmentative and Alternative Communication in Early Intervention. Accessed July 21, 2026.
- Centers for Medicare & Medicaid Services. National Coverage Determination 50.1: Speech Generating Devices. Current version effective July 29, 2015.
- Centers for Medicare & Medicaid Services. Speech Generating Devices Policy Article A52469. Accessed July 21, 2026.