E-stim Treatment: Is It Billable? Medicare reimburses e-stim only as part of a broader swallowing treatment program. Bottom Line
Free
Bottom Line  |   October 01, 2015
E-stim Treatment: Is It Billable?
Author Notes
  • Lisa Satterfield, MS, CCC-A, is director of ASHA health care regulatory advocacy. lsatterfield@asha.org
    Lisa Satterfield, MS, CCC-A, is director of ASHA health care regulatory advocacy. lsatterfield@asha.org×
  • Neela Swanson is director of ASHA health care coding policy. nswanson@asha.org
    Neela Swanson is director of ASHA health care coding policy. nswanson@asha.org×
Article Information
Swallowing, Dysphagia & Feeding Disorders / Practice Management / Bottom Line
Bottom Line   |   October 01, 2015
E-stim Treatment: Is It Billable?
The ASHA Leader, October 2015, Vol. 20, 30. doi:10.1044/leader.BML.20102015.30
The ASHA Leader, October 2015, Vol. 20, 30. doi:10.1044/leader.BML.20102015.30
As health care payers focus on audits and recovery of inappropriate payments, Medicare contractors and health care administrators are scrutinizing appropriate billing practices. For speech-language pathologists, one area being watched is billing for the use of neuromuscular electrical stimulation (e-stim) in swallowing treatment.
Medicare has determined that, as a standalone treatment, e-stim (such as VitalStim) lacks an appropriate evidence base and fails to meet the standards of care for coverage. In National Coverage Determination (NCD) 160.2, Medicare prohibits the use of e-stim for motor function disorders. Many Medicare Administrative Contractors have further delineated in policy that e-stim related to swallowing treatment is not covered.
E-stim may, however, be included as part of broader treatment for swallowing under CPT code 92526 (Current Procedural Terminology®, American Medical Association).
SLPs bill swallowing treatment under CPT 92526 (treatment of swallowing dysfunction and/or oral function for feeding). Medicare recognized SLPs as providers of swallowing treatment in 1989 with NCD 170.3, indicating that swallowing treatment performed by SLPs may 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.”

Documentation must clearly define the primary swallowing treatment and distinguish the use of e-stim as a separate procedure or one that is supplemental to the (re)habilitative techniques.

SLPs using e-stim should follow some guidelines to bill correctly for swallowing treatment:
  • It is not appropriate to bill Medicare for swallowing treatment when e-stim is the primary or only method of treatment used.

  • It is not appropriate to bill Medicare for the electrodes or supplies used for e-stim. Electrodes are considered equipment and a part of the procedure that is provided.

  • It is appropriate to bill Medicare for CPT 92526 when comprehensive, compensatory training and (re)habilitative techniques are the primary treatment methods used with or without e-stim.

  • Documentation must clearly define the primary swallowing treatment and distinguish the use of e-stim as a separate procedure or one that is supplemental to the comprehensive, compensatory training and/or (re)habilitative techniques that meet the definition in Medicare’s NCD 170.3.

  • Electrical stimulation equipment manufacturers describe the treatment as an adjunct to traditional swallowing treatment, suggesting it is not appropriate to be performed in isolation.

Other third-party payers may have different policies. Check with each individual payer.
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
October 2015
Volume 20, Issue 10