ASHA Disputes Videostroboscopy Supervision Rule ASHA is protesting new Medicare regulations that require “personal” (in-the-room) supervision by a physician when a speech-language pathologist performs videostroboscopy or nasopharyngoscopy. The new regulation by the Centers for Medicare and Medicaid Services (CMS), which became effective Jan.1, requires a physician to be present in the examining room (not just ... ASHA News
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ASHA News  |   February 01, 2011
ASHA Disputes Videostroboscopy Supervision Rule
Author Notes
  • Mark Kander, director of health care regulatory analysis, can be reached at mkander@asha.org.
    Mark Kander, director of health care regulatory analysis, can be reached at mkander@asha.org.×
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Speech, Voice & Prosodic Disorders / Voice Disorders / Professional Issues & Training / ASHA News & Member Stories / ASHA News
ASHA News   |   February 01, 2011
ASHA Disputes Videostroboscopy Supervision Rule
The ASHA Leader, February 2011, Vol. 16, 9. doi:10.1044/leader.AN2.16022011.9
The ASHA Leader, February 2011, Vol. 16, 9. doi:10.1044/leader.AN2.16022011.9
ASHA is protesting new Medicare regulations that require “personal” (in-the-room) supervision by a physician when a speech-language pathologist performs videostroboscopy or nasopharyngoscopy.
The new regulation by the Centers for Medicare and Medicaid Services (CMS), which became effective Jan.1, requires a physician to be present in the examining room (not just in the office suite, as previously required) when an SLP performs a videostroboscopy (CPT 31579; Common Procedural Terminology, ©American Medical Association) or a nasopharyngoscopy (CPT 92511).
CMS did not announce this new requirement—the change is identified only in the 2011 fee schedule “look-up” site. (To locate the supervision levels, type in 31579 and/or 92511 and select “all modifiers.” Then select MEDICAL POLICY. In the next screen at bottom see PHYS SUPV; the digit “3” represents personal supervision.)
Under Medicare rules, physician supervisors of diagnostic tests for hospital outpatients must have the knowledge and ability to perform the procedure; in non-hospital settings, any physician fulfills the supervision requirement.
ASHA contends that the supervision level be returned to “direct” (present in the office suite) because:
  • Videostroboscopy is performed safely by SLPs.

  • Regional Medicare administrative contractors do not require personal supervision for similar endoscopic procedures by SLPs.

  • Personal supervision is an inefficient use of physician time.

ASHA also notes that the change was made without any notice or consultation with the professional organizations of those affected by the new regulation—SLPs and otolaryngologists—and without public notice of consideration to revise the policy.
ASHA has position statements, guidelines, technical reports, and knowledge and skills documents for endoscopy, including Vocal Tract Visualization and Imaging (1992; updated in 2004), Knowledge and Skills for Speech-Language Pathologists With Respect to Vocal Tract Visualization and Imaging (2004), and Use of Endoscopy by Speech-Language Pathologists (2008). These official ASHA documents demonstrate the long-standing inclusion of endoscopic procedures within the speech-language pathology scope of practice. SLPs have the ethical obligation to attain these skills and should be able to document proof of knowledge and skills through an appropriate process in their employment settings.
ASHA is working with other health care organizations to press CMS to reverse the policy. Check ASHA’s website or “News Watch” at The ASHA Leader online for updates or subscribe to ASHA’s “Headlines” service for e-mail notification of regulatory changes and other late-breaking news (send a blank e-mail with the word “subscribe” in the subject line to asha-headlines-request@lists.asha.org).
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February 2011
Volume 16, Issue 2