Local Coverage Determination (LCD)

Home Health-Surface Electrical Stimulation in the Treatment of Dysphagia

L34565

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Contractor Information

Contractor Name	Contract Type	Contract Number	Jurisdiction	States
Palmetto GBA	A and B and HHH MAC	11004 - HHH MAC	J - M	Alabama Arkansas Florida Georgia Illinois Indiana Kentucky Louisiana Mississippi New Mexico North Carolina Ohio Oklahoma South Carolina Tennessee Texas

LCD Information

Document Information

LCD ID
L34565

LCD Title
Home Health-Surface Electrical Stimulation in the Treatment of Dysphagia

Proposed LCD in Comment Period
N/A

Source Proposed LCD
N/A

Original Effective Date
For services performed on or after 10/01/2015

Revision Effective Date
For services performed on or after 10/31/2019

Revision Ending Date
N/A

Retirement Date
N/A

Notice Period Start Date
N/A

Notice Period End Date
N/A

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Copyright © 2022, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act, §1814(a)(2)(C) Requirement of Requests and Certifications

42 CFR §409.42-Beneficiary qualifications for coverage of services

42 CFR §409.43 Plan of care requirements

42 CFR §424.22-Requirements for Home Health Services

CMS Internet-Only Manual, Pub 100-08, Medicare Program Integrity Manual, Chapter 6, §§6.2, 6.2.1, 6.2.1.1, 6.2.2, 6.2.2.1, 6.2.3, 6.2.5, and 6.2.6

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

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 (SSA)and will not be covered by this A/B Medicare Administrative Contractor (MAC) (HHH).

Summary of Evidence

N/A

Analysis of Evidence (Rationale for Determination)

N/A

General Information

Associated Information

Documentation Requirements

In order for Home Health (HH) patients to be eligible to receive services under the Medicare HH benefit the following must be documented for certification/re-certification:

a) Patient is under physician care.
b) Homebound status-with documentation of confinement to home in medical records.
c) Established Plan of Care-must be signed and dated by the certifying physician.
d) Face-to-Face-no more than 90 days prior or 30 days after start of HH care.
e) Skilled need services must be medically necessary and documentation of the skilled need should be in the patient's medical records.

If the requirements for certification are not met, claims for subsequent episodes of care (which require a re-certification) will not be covered, even if the requirements for re-certifications are met. Re-certifications are needed at least every 60 days when there is a need for continuing home care.

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

Sources of Information
N/A

Bibliography

Blumenfeld L, Hahn Y, LePage A, Leonard R, Belafsky PC. Transcutaneous electrical stimulation vs. traditional dysphagia therapy: a non-concurrent cohort study. Otolaryngol Head and Neck Surg. 2006;135(5):754-757.

Burnett TA, Mann EA, Stoklosa JB, Ludlow CL. Self-triggered functional electrical stimulation during swallowing. Jour Neurophysiol. 2005;94(6):4011-4018.

Chaudhuri G, Brady S, Caldwell R. Electrical stimulation for dysphagia following stroke: pilot data. Arch Phys Med Rehab. 2006;87(11):e51.

Crary MA, Carnaby-Mann GD, Faunce A. Electrical stimulation therapy for dysphagia: descriptive results of two surveys. Dysphagia. 2007;22(3):165-173.

D’Souza K, Krieger R, Kobe C. Effect of electrical stimulation on swallow function in patient with polymyositis: a case report. Arch Phys Med Rehab. 2006;87(11):e14.

Empi Recovery Sciences. Neuromuscular electrical stimulation in the treatment of dysphagia: a summary of the evidence. March 2009.

Humbert IA, Poletto CJ, Saxon KG, et al. The effect of surface electrical stimulation on hyo-laryngeal movement in normal individuals at rest and during swallowing. Jour Appl Physiol. 2006;101(6):1657-1663.

Kong KH, Yang SI, et al. Peer reviewed Poster 275-Academy Annual Assembly Abstracts. Mood, functional status and quality of life among chronic stroke survivors attending a rehabilitation clinic. Arch Phys Med Rehabil.2006;87(11):e51.

Geater A, Leelamanit V, Limsakul C. Synchronized electrical stimulation in treating pharyngeal dysphagia. The Laryngoscope. 2002;112(12):2204-2210.

Ludlow CL, Humbert I, Saxon K, Poletto C, Sonies B, Crujido L. Effects of surface electrical stimulation both at rest and during swallowing in chronic pharyngeal dysphagia. Dysphagia. 2007;22(1):1-10.

Permsirivanich W, Tipchatyotin S, Wongchai M, et al. Comparing the effects of rehabilitative swallowing therapy vs. neuromuscular electrical stimulation therapy among stroke patients with persistent pharyngeal dysphagia: a randomized controlled study. Jour Thai Med Assoc. 2009;92(2):259-65.

Shaw GY, Sechtem PR, Searl J, Keller K, Rawi TA, Dowdy E. Transcutaneous neuromuscular electrical stimulation (VitalStim) curative therapy for severe dysphagia: myth or reality? Annals of Otology, Rhinology & Laryngology. 2007;116(1):36–44.

Revision History Information

Revision History Date	Revision History Number	Revision History Explanation	Reasons for Change
10/31/2019	R10	This LCD is being revised in order to adhere to CMS requirements per Chapter 13, Section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs. There has been no change in coverage with this LCD revision. Regulations regarding billing and coding were removed from the *CMS National Coverage Policy* section of this LCD and placed in the related Billing and Coding: Home Health-Surface Electrical Stimulation in the Treatment of Dysphagia A56648 article.	Provider Education/Guidance
07/04/2019	R9	All coding located in the Coding Information section has been moved into the related Billing and Coding: Home Health-Surface Electrical Stimulation in the Treatment of Dysphagia A56648 article and removed from the LCD. At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.	Provider Education/Guidance
04/25/2019	R8	Under *Associated Information – Documentation Requirements* the word “patient” was changed to “patient’s.” Under *Bibliography* changes were made to citations to reflect AMA citation guidelines. Punctuation and typographical errors were corrected throughout the LCD. Acronyms were inserted where appropriate throughout the LCD. At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.	Provider Education/Guidance
11/08/2018	R7	Under Associated Information-Documentation Requirements punctuation and grammar were corrected and words were capitalized or changed to lower case as appropriate. Under *Bibliography* changes were made to reflect AMA citation guidelines. At this time 21^stCentury Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.	Provider Education/Guidance Public Education/Guidance
11/09/2017	R6	Under CMS National Coverage Policy deleted CMS Internet-Only Manual , Pub 100-04, Medicare Claims Processing Manual, Chapter 1 reference and corrected typographical errors, capitalized the first letter in “request” and “certification” to Title XVIII of the Social Security Act, §1814, and corrected CMS Internet-Only Manual, Pub 100-08 title. Under Associated Information, corrected grammatical errors. Under Sources of Information and Basis for Decision corrected punctuation errors, typographical and spelling errors, added author initials and author names, and added “Neuromuscular” to the cited article by Permisirivanch W., Tipchatyotin S., Wongchai M., et al. All referenced citations were moved to the Bibliography section of the policy. At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.	Provider Education/Guidance Other (Annual Validation)
12/29/2016	R5	Under *CMS National Coverage Policy* added the word “Services” to 42 CFR §424.22 verbiage to now read “Requirements for Home Health Services”. Deleted Change Request 9189, Transmittal 603, dated July 21, 2015 as this was manualized and is now found in the CMS Internet-Only Manual, Pub 100-08, Medicare Integrity Program Manual, Chapter 6, §§6.2, 6.2.1, 6.2.1.1, 6.2.2, 6.2.2.1, 6.2.3, 6.2.4, 6.2.5, 6.2.6 and 6.2.7. Under *Sources of Information and Basis for Decision* added author’s name and supplement numbers to various journal titles.	Provider Education/Guidance Other (Annual Validation)
01/07/2016	R4	Under CMS National Coverage Policy removed CMS Internet-Only Manual, Pub 100-04, Medicare Claims Processing Manual, Transmittal 2694, dated May 3, 2013, Change Request 8244 as this information has been manualized in the following sections: CMS Internet-Only Manual, Pub 100-04, Medicare Claims Processing Manual, Chapter 1 General Billing Requirements, §60.4; CMS Internet-Only Manual, Pub 100-04, Medicare Claims Processing Manual, Chapter 10 Home Health Agency Billing, §§10.1.10.4, 30.11, 40.1-40.2, 40.4, 70.1 and 90-90.1.	Provider Education/Guidance Public Education/Guidance Other (Annual Validation)
10/01/2015	R3	Under *CMS National Coverage Policy* added the following: 42 CFR §424.22-Requirements for Home Health, 42 CFR §409.42-Beneficiary qualifications for coverage of services, §409.43 Plan of care requirements, Title XVIII of the Social Security Act, §1835 (a)(2)(A) Procedure for payment of claims of providers of services, Title XVIII of the Social Security Act, §1814 (a)(2)(C) Requirements of requests and certifications and CMS Internet-Only Manual, Pub 100-08, Medicare Program Integrity Manual, Transmittal 603, dated July 21, 2015, Change Request 9189. Under *Associated Information-Documentation Requirements* added the requirements for certification/recertification. Under *Sources of Information and Basis for Decision* corrected citations in the AMA citation format.	Provider Education/Guidance Other (Change Request 9189, Transmittal 603)
10/01/2015	R2	Per CMS Internet-Only Manual, Pub 100-08, Medicare Program Integrity Manual, Chapter 13, §13.1.3 LCDs consist of only “reasonable and necessary” information. All bill type and revenue codes have been removed.	Other (Bill type and revenue code removal)
10/01/2015	R1	Under CMS National Coverage Policy, added the citation for CMS Internet-Only Manual, 100-04, Medicare Claims Processing Manual to reference CR8244. Under Bill Type removed Code 033x per CR8244. Under Sources of Information and Basis of Information, added citations for Blumenfeld, Hahn, LePage, et al; Burnett, Mann, et al; Chaudhuri, Brady, Caldwell; Crary, Carnaby-Mann, Faunce; D’Souza, Krieger, Kobe; Empi recovery sciences; Humbert, Poletto, et al; Kong; Leelamanit, Limsakul; and Permsirivanich.	Provider Education/Guidance Other (Annual Validation)

Associated Documents

Attachments
N/A

Related Local Coverage Documents
Articles
A56648 - Billing and Coding: Home Health-Surface Electrical Stimulation in the Treatment of Dysphagia

Updated On	Effective Dates	Status
11/15/2019	10/31/2019 - N/A	Currently in Effect	You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

Surface Electrical Stimulation in the Treatment of Dysphagia
Dysphagia
Home Health

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Home Health-Surface Electrical Stimulation in the Treatment of Dysphagia

Contractor Information

LCD Information

Document Information

CMS National Coverage Policy

Coverage Guidance

General Information

Revision History Information

Associated Documents

Keywords

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