L31534 HOME HEALTH-SURFACE ELECTRICAL STIMULATION

IN THE TREATMENT OF DYSPHAGIA

 

 

Region IV J11HH-11-005-L

 

10/04/2012

 

 

• Surface electrical stimulation in the treatment of dysphagia is being used by some Medicare providers as an adjunct to “usual care”.

• There is insufficient scientific or clinical evidence to consider this device as reasonable and necessary for the treatment of dysphagia within the meaning of §1862(a)(1)(A) of the Social Security Act and will NOT be covered by this Intermediary.

 

 

Bill Type Codes:

 

• Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service.

• Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type.

• Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

 

032x Home Health - Inpatient (plan of treatment under Part B only)

033x Home Health - Outpatient (plan of treatment under Part A, including DME under Part A)

 

 

Revenue Codes:

 

• Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service.

• In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination.

• Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

 

0420  Physical Therapy - General Classification

0421  Physical Therapy - Visit

0422  Physical Therapy - Hourly

0424  Physical Therapy - Evaluation or Re-evaluation

0429  Physical Therapy - Other Physical Therapy

0430  Occupational Therapy - General Classification

0431  Occupational Therapy - Visit

0432  Occupational Therapy - Hourly

0434  Occupational Therapy - Evaluation or Reevaluation

0439  Occupational Therapy - Other Occupational Therapy

0440  Speech Therapy - Language Pathology - General Classification

0441  Speech Therapy - Language Pathology - Visit

0449  Speech Therapy - Language Pathology - Other Speech Therapy

 

 

ICD-9 Codes that Support Medical Necessity

 

XX000 Not Applicable

 

Diagnoses that Support Medical Necessity

 

 

ICD-9 Codes that DO NOT Support Medical Necessity

 

787.20  DYSPHAGIA, UNSPECIFIED

787.21  DYSPHAGIA, ORAL PHASE

787.22  DYSPHAGIA, OROPHARYNGEAL PHASE

787.23  DYSPHAGIA, PHARYNGEAL PHASE

787.24  DYSPHAGIA, PHARYNGOESOPHAGEAL PHASE

787.29  OTHER DYSPHAGIA

 

 

Documentations Requirements

 

• Documentation supporting the medical necessity should be legible, maintained in the patient’s medical record, and must be made available to the A/B MAC upon request.

 

 

Sources of Information and Basis for Decision

 

Ludlow CL, Humbert I, Saxon K, et al. Effects of Surface Electrical Stimulation Both at Rest and During Swallowing in Chronic Pharyngeal Dysphagia. Dysphagia. 2007 January; 22(1): 1-10.

 

Shaw GY, Sechtem MS, Searl J et al. Transcutaneous Neuromuscular Electrical Stimulation (VitalStim) Curative Therapy for Severe Dysphagia: Myth or Reality? 01-JAN-2007; Annals of Otology, Rhinology & Laryngology. 116(1):36 – 44.

 

Local Coverage Determination (LCD) for Home Health-Surface Electrical Stimulation in the Treatment of Dysphagia (L31534)