LCD/NCD Portal

NCD170.3

 

SPEECH-LANGUAGE PATHOLOGY SERVICES FOR THE TREATMENT OF DYSPHAGIA

 

Effective Date of this Version

10/2/2006

 

Benefit Category

• Outpatient Speech Language Pathology Services.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

Item/Service Description

• Dysphagia is a swallowing disorder that may be due to various neurological, structural, and cognitive deficits.

o Dysphagia may be the result of head trauma, cerebrovascular accident, neuromuscular degenerative diseases, head and neck cancer, and encephalopathies.

o While dysphagia can afflict any age group, it most often appears among the elderly.

• Patients who are motivated, moderately alert and have some degree of deglutition and swallowing functions are appropriate candidates for dysphagia therapy.

o Elements of the therapy program can include thermal stimulation to heighten the sensitivity of the swallowing reflex, exercises to improve oral-motor control, training in laryngeal adduction and compensatory swallowing techniques, and positioning and dietary modifications.

o Design all programs to ensure swallowing safety of the patient during oral feedings and maintain adequate nutrition.

 

Indications and Limitations of Coverage

• Speech-language pathology services are covered under Medicare for the treatment of dysphagia, regardless of the presence of a communication disability.

 

Cross Reference

• The Medicare Benefit Policy Manual, Chapter 15, "Covered Medical and Other Health Services," §§220 and 230.3.

 

Claims Processing Instructions

• TN 941 (Medicare Claims Processing)

 

Coverage Transmittal Link

• http://www.cms.gov/transmittals/downloads/R55NCD.pdf

 

Medicare NCD Link