Medicare Repeals Endoscopy Rules As of Oct. 1, 2011, Medicare will no longer require speech-language pathologists performing videostroboscopy or nasopharyngoscopy to be supervised by physicians. The Centers for Medicare and Medicaid Services (CMS) instituted a requirement on Jan. 1, 2011, that a physician be in the room supervising an SLP performing the procedures. This ... Policy Analysis
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Policy Analysis  |   September 01, 2011
Medicare Repeals Endoscopy Rules
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.×
  • Kate Romanow, JD, director of health care regulatory advocacy, can be reached at kromanow@asha.org.
    Kate Romanow, JD, director of health care regulatory advocacy, can be reached at kromanow@asha.org.×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   September 01, 2011
Medicare Repeals Endoscopy Rules
The ASHA Leader, September 2011, Vol. 16, 1-6. doi:10.1044/leader.PA1.16092011.1
The ASHA Leader, September 2011, Vol. 16, 1-6. doi:10.1044/leader.PA1.16092011.1
As of Oct. 1, 2011, Medicare will no longer require speech-language pathologists performing videostroboscopy or nasopharyngoscopy to be supervised by physicians.
The Centers for Medicare and Medicaid Services (CMS) instituted a requirement on Jan. 1, 2011, that a physician be in the room supervising an SLP performing the procedures. This rule replaced “direct” supervision requiring a physician to be “immediately available” in the office suite but not necessarily in the room during the procedure (The ASHA Leader, Feb. 15, 2011).
In response to this onerous requirement, ASHA members instituted a letter-writing campaign to their congressional representatives, explaining the unreasonable nature of the supervisory restriction.
In addition, ASHA sent a formal request to CMS for reconsideration of the rule and, with representatives from the medical community, met with CMS staff on this issue. In preparation for that meeting, ASHA Special Interest Group 3, Voice and Voice Disorders, prepared information and gathered data.
Surprisingly, the CMS response to the issue first arrived in late June as a letter from CMS Administrator Donald Berwick to Sen. Susan M. Collins (R-Maine) on behalf of SLP Michael Towey, manager of the Voice and Swallowing Center of Maine. CMS acknowledged that “while physicians perform these diagnostic procedures, speech pathologists also perform these procedures to evaluate and treat a patient’s functional/use problems.” The CMS letter to ASHA confirming the decision can be found on ASHA’s website [PDF].
The CMS letter removed all Medicare supervision levels previously assigned to the procedures, effective Oct. 1. Thus, a properly trained SLP performing videostroboscopy or nasopharyngoscopy [31579 and 92511, respectively, under Current Procedural Terminology (CPT), ©American Medical Association] will not need physician supervision or proximity.
Physician availability during such procedures—including videostroboscopy and nasopharyngoscopy—is still specified in some state laws. Other state laws require SLPs perfoming endoscopic prodedures to receive training supervised or verified by physicians. Because no national supervision level is established, individual Medicare administrative contractors may establish local supervision requirements for these procedures in their local coverage determinations.
The change also does not diminish the vital role of otolaryngologists, as indicated in ASHA’s Preferred Practice Patterns for Voice: “All patients/clients with voice disorders are examined by a physician, preferably in a discipline appropriate to the presenting complaint.”
The CMS decision regarding videostroboscopy and nasopharyngoscopy does not affect fiberoptic endoscopic examination of swallowing (FEES; CPT 92612) or other endoscopy procedures. Supervision levels for FEES continue to be determined by MACs.
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September 2011
Volume 16, Issue 9