SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Barium Swallow Studies, Modified

A56589

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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To see the currently-in-effect version of this document, go to the section.

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General Information

Source Article ID
N/A
Article ID
A56589
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Barium Swallow Studies, Modified
Article Type
Billing and Coding
Original Effective Date
05/30/2019
Revision Effective Date
10/01/2021
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, 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

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L35433, Barium Swallow Studies, Modified. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

CPT codes 70370, 70371 and 74230 describe the complete barium swallow study and should only be billed one time per patient on the same date of service. Only one of these CPT codes should be billed per patient on the same date of service.

Documentation Requirements

  1. All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
021x Skilled Nursing - Inpatient (Including Medicare Part A)
022x Skilled Nursing - Inpatient (Medicare Part B only)
023x Skilled Nursing - Outpatient
075x Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF)
085x Critical Access Hospital
N/A

Revenue Codes

Code Description
032X Radiology - Diagnostic - General Classification
044X Speech-Language Pathology - General Classification
N/A

CPT/HCPCS Codes

Group 1

(3 Codes)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
Code Description
70370 Throat x-ray & fluoroscopy
70371 Speech evaluation complex
74230 X-ray xm swlng funcj c+
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(14 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

Report dysphagia with the primary diagnosis of I69.091, I69.191, I69.291, I69.391, I69.891, I69.991, J69.0, R13.0, R13.10-R13.14 or R13.19. At least one of the secondary diagnoses from the secondary diagnoses list below is required for R13.0, R13.10-R13.14 and R13.19. ICD-10 codes I69.091, I69.191, I69.291, I69.391, I69.891, I69.991 and J69.0 do not require a secondary diagnosis)

Medicare is establishing the following limited coverage for CPT/HCPCS codes 70370, 70371 and 74230: Primary Diagnosis

Group 1 Codes
Code Description
I69.091 Dysphagia following nontraumatic subarachnoid hemorrhage
I69.191 Dysphagia following nontraumatic intracerebral hemorrhage
I69.291 Dysphagia following other nontraumatic intracranial hemorrhage
I69.391 Dysphagia following cerebral infarction
I69.891 Dysphagia following other cerebrovascular disease
I69.991 Dysphagia following unspecified cerebrovascular disease
J69.0 Pneumonitis due to inhalation of food and vomit
R13.0 Aphagia
R13.10 Dysphagia, unspecified
R13.11 Dysphagia, oral phase
R13.12 Dysphagia, oropharyngeal phase
R13.13 Dysphagia, pharyngeal phase
R13.14 Dysphagia, pharyngoesophageal phase
R13.19 Other dysphagia

Group 2

(444 Codes)
Group 2 Paragraph

The following are secondary (dual) diagnoses to be used with R13.0, R13.10-R13.14 and R13.19 (primary diagnosis) to meet limited coverage for CPT/HCPCS codes 70370, 70371 and 74230: 

Secondary Diagnosis:

Group 2 Codes
Code Description
A31.0 Pulmonary mycobacterial infection
B91 Sequelae of poliomyelitis
C00.0 Malignant neoplasm of external upper lip
C00.1 Malignant neoplasm of external lower lip
C00.2 Malignant neoplasm of external lip, unspecified
C00.3 Malignant neoplasm of upper lip, inner aspect
C00.4 Malignant neoplasm of lower lip, inner aspect
C00.5 Malignant neoplasm of lip, unspecified, inner aspect
C00.6 Malignant neoplasm of commissure of lip, unspecified
C00.8 Malignant neoplasm of overlapping sites of lip
C00.9 Malignant neoplasm of lip, unspecified
C01 Malignant neoplasm of base of tongue
C02.0 Malignant neoplasm of dorsal surface of tongue
C02.1 Malignant neoplasm of border of tongue
C02.2 Malignant neoplasm of ventral surface of tongue
C02.3 Malignant neoplasm of anterior two-thirds of tongue, part unspecified
C02.4 Malignant neoplasm of lingual tonsil
C02.8 Malignant neoplasm of overlapping sites of tongue
C02.9 Malignant neoplasm of tongue, unspecified
C03.0 Malignant neoplasm of upper gum
C03.1 Malignant neoplasm of lower gum
C03.9 Malignant neoplasm of gum, unspecified
C04.0 Malignant neoplasm of anterior floor of mouth
C04.1 Malignant neoplasm of lateral floor of mouth
C04.8 Malignant neoplasm of overlapping sites of floor of mouth
C04.9 Malignant neoplasm of floor of mouth, unspecified
C05.0 Malignant neoplasm of hard palate
C05.1 Malignant neoplasm of soft palate
C05.2 Malignant neoplasm of uvula
C05.8 Malignant neoplasm of overlapping sites of palate
C05.9 Malignant neoplasm of palate, unspecified
C06.0 Malignant neoplasm of cheek mucosa
C06.1 Malignant neoplasm of vestibule of mouth
C06.2 Malignant neoplasm of retromolar area
C06.80 Malignant neoplasm of overlapping sites of unspecified parts of mouth
C06.89 Malignant neoplasm of overlapping sites of other parts of mouth
C06.9 Malignant neoplasm of mouth, unspecified
C07 Malignant neoplasm of parotid gland
C08.0 Malignant neoplasm of submandibular gland
C08.1 Malignant neoplasm of sublingual gland
C08.9 Malignant neoplasm of major salivary gland, unspecified
C09.0 Malignant neoplasm of tonsillar fossa
C09.1 Malignant neoplasm of tonsillar pillar (anterior) (posterior)
C09.8 Malignant neoplasm of overlapping sites of tonsil
C09.9 Malignant neoplasm of tonsil, unspecified
C10.0 Malignant neoplasm of vallecula
C10.1 Malignant neoplasm of anterior surface of epiglottis
C10.2 Malignant neoplasm of lateral wall of oropharynx
C10.3 Malignant neoplasm of posterior wall of oropharynx
C10.4 Malignant neoplasm of branchial cleft
C10.8 Malignant neoplasm of overlapping sites of oropharynx
C10.9 Malignant neoplasm of oropharynx, unspecified
C11.0 Malignant neoplasm of superior wall of nasopharynx
C11.1 Malignant neoplasm of posterior wall of nasopharynx
C11.2 Malignant neoplasm of lateral wall of nasopharynx
C11.3 Malignant neoplasm of anterior wall of nasopharynx
C11.8 Malignant neoplasm of overlapping sites of nasopharynx
C11.9 Malignant neoplasm of nasopharynx, unspecified
C12 Malignant neoplasm of pyriform sinus
C13.0 Malignant neoplasm of postcricoid region
C13.1 Malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect
C13.2 Malignant neoplasm of posterior wall of hypopharynx
C13.8 Malignant neoplasm of overlapping sites of hypopharynx
C13.9 Malignant neoplasm of hypopharynx, unspecified
C14.0 Malignant neoplasm of pharynx, unspecified
C14.2 Malignant neoplasm of Waldeyer's ring
C14.8 Malignant neoplasm of overlapping sites of lip, oral cavity and pharynx
C15.3 Malignant neoplasm of upper third of esophagus
C15.4 Malignant neoplasm of middle third of esophagus
C15.5 Malignant neoplasm of lower third of esophagus
C15.8 Malignant neoplasm of overlapping sites of esophagus
C15.9 Malignant neoplasm of esophagus, unspecified
C30.0 Malignant neoplasm of nasal cavity
C30.1 Malignant neoplasm of middle ear
C31.0 Malignant neoplasm of maxillary sinus
C31.1 Malignant neoplasm of ethmoidal sinus
C31.2 Malignant neoplasm of frontal sinus
C31.3 Malignant neoplasm of sphenoid sinus
C31.8 Malignant neoplasm of overlapping sites of accessory sinuses
C32.0 Malignant neoplasm of glottis
C32.1 Malignant neoplasm of supraglottis
C32.2 Malignant neoplasm of subglottis
C32.3 Malignant neoplasm of laryngeal cartilage
C32.8 Malignant neoplasm of overlapping sites of larynx
C32.9 Malignant neoplasm of larynx, unspecified
C76.0 Malignant neoplasm of head, face and neck
C77.0 Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck
C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct
C78.80 Secondary malignant neoplasm of unspecified digestive organ
C78.89 Secondary malignant neoplasm of other digestive organs
D10.1 Benign neoplasm of tongue
D10.2 Benign neoplasm of floor of mouth
D10.30 Benign neoplasm of unspecified part of mouth
D10.39 Benign neoplasm of other parts of mouth
D10.4 Benign neoplasm of tonsil
D10.5 Benign neoplasm of other parts of oropharynx
D10.6 Benign neoplasm of nasopharynx
D10.7 Benign neoplasm of hypopharynx
D10.9 Benign neoplasm of pharynx, unspecified
D11.0 Benign neoplasm of parotid gland
D11.7 Benign neoplasm of other major salivary glands
D11.9 Benign neoplasm of major salivary gland, unspecified
D13.0 Benign neoplasm of esophagus
D38.0 Neoplasm of uncertain behavior of larynx
D49.1 Neoplasm of unspecified behavior of respiratory system
F44.4 Conversion disorder with motor symptom or deficit
F44.7 Conversion disorder with mixed symptom presentation
G10 Huntington's disease
G12.21 Amyotrophic lateral sclerosis
G12.22 Progressive bulbar palsy
G12.23 Primary lateral sclerosis
G12.24 Familial motor neuron disease
G12.25 Progressive spinal muscle atrophy
G12.29 Other motor neuron disease
G12.8 Other spinal muscular atrophies and related syndromes
G14 Postpolio syndrome
G20 Parkinson's disease
G21.0 Malignant neuroleptic syndrome
G21.11 Neuroleptic induced parkinsonism
G21.19 Other drug induced secondary parkinsonism
G21.2 Secondary parkinsonism due to other external agents
G21.3 Postencephalitic parkinsonism
G21.4 Vascular parkinsonism
G21.8 Other secondary parkinsonism
G21.9 Secondary parkinsonism, unspecified
G23.0 Hallervorden-Spatz disease
G23.1 Progressive supranuclear ophthalmoplegia [Steele-Richardson-Olszewski]
G23.2 Striatonigral degeneration
G23.8 Other specified degenerative diseases of basal ganglia
G23.9 Degenerative disease of basal ganglia, unspecified
G24.09 Other drug induced dystonia
G24.1 Genetic torsion dystonia
G24.2 Idiopathic nonfamilial dystonia
G24.3 Spasmodic torticollis
G24.4 Idiopathic orofacial dystonia
G24.5 Blepharospasm
G24.8 Other dystonia
G24.9 Dystonia, unspecified
G25.3 Myoclonus
G25.4 Drug-induced chorea
G25.5 Other chorea
G25.70 Drug induced movement disorder, unspecified
G25.71 Drug induced akathisia
G25.79 Other drug induced movement disorders
G25.82 Stiff-man syndrome
G25.83 Benign shuddering attacks
G25.89 Other specified extrapyramidal and movement disorders
G25.9 Extrapyramidal and movement disorder, unspecified
G26 Extrapyramidal and movement disorders in diseases classified elsewhere
G35 Multiple sclerosis
G36.0 Neuromyelitis optica [Devic]
G36.1 Acute and subacute hemorrhagic leukoencephalitis [Hurst]
G36.8 Other specified acute disseminated demyelination
G36.9 Acute disseminated demyelination, unspecified
G37.0 Diffuse sclerosis of central nervous system
G37.1 Central demyelination of corpus callosum
G37.2 Central pontine myelinolysis
G37.3 Acute transverse myelitis in demyelinating disease of central nervous system
G37.4 Subacute necrotizing myelitis of central nervous system
G37.5 Concentric sclerosis [Balo] of central nervous system
G37.8 Other specified demyelinating diseases of central nervous system
G37.9 Demyelinating disease of central nervous system, unspecified
G70.00 Myasthenia gravis without (acute) exacerbation
G70.01 Myasthenia gravis with (acute) exacerbation
G71.01 Duchenne or Becker muscular dystrophy
G71.09 Other specified muscular dystrophies
G80.3 Athetoid cerebral palsy
G80.4 Ataxic cerebral palsy
G80.8 Other cerebral palsy
G81.00 Flaccid hemiplegia affecting unspecified side
G81.01 Flaccid hemiplegia affecting right dominant side
G81.02 Flaccid hemiplegia affecting left dominant side
G81.03 Flaccid hemiplegia affecting right nondominant side
G81.04 Flaccid hemiplegia affecting left nondominant side
G81.10 Spastic hemiplegia affecting unspecified side
G81.11 Spastic hemiplegia affecting right dominant side
G81.12 Spastic hemiplegia affecting left dominant side
G81.13 Spastic hemiplegia affecting right nondominant side
G81.14 Spastic hemiplegia affecting left nondominant side
G81.90 Hemiplegia, unspecified affecting unspecified side
G81.91 Hemiplegia, unspecified affecting right dominant side
G81.92 Hemiplegia, unspecified affecting left dominant side
G81.93 Hemiplegia, unspecified affecting right nondominant side
G81.94 Hemiplegia, unspecified affecting left nondominant side
G82.50 Quadriplegia, unspecified
G82.51 Quadriplegia, C1-C4 complete
G82.52 Quadriplegia, C1-C4 incomplete
G82.53 Quadriplegia, C5-C7 complete
G82.54 Quadriplegia, C5-C7 incomplete
G90.3 Multi-system degeneration of the autonomic nervous system
I63.30 Cerebral infarction due to thrombosis of unspecified cerebral artery
I63.311 Cerebral infarction due to thrombosis of right middle cerebral artery
I63.312 Cerebral infarction due to thrombosis of left middle cerebral artery
I63.313 Cerebral infarction due to thrombosis of bilateral middle cerebral arteries
I63.319 Cerebral infarction due to thrombosis of unspecified middle cerebral artery
I63.321 Cerebral infarction due to thrombosis of right anterior cerebral artery
I63.322 Cerebral infarction due to thrombosis of left anterior cerebral artery
I63.323 Cerebral infarction due to thrombosis of bilateral anterior cerebral arteries
I63.329 Cerebral infarction due to thrombosis of unspecified anterior cerebral artery
I63.331 Cerebral infarction due to thrombosis of right posterior cerebral artery
I63.332 Cerebral infarction due to thrombosis of left posterior cerebral artery
I63.333 Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries
I63.339 Cerebral infarction due to thrombosis of unspecified posterior cerebral artery
I63.341 Cerebral infarction due to thrombosis of right cerebellar artery
I63.342 Cerebral infarction due to thrombosis of left cerebellar artery
I63.343 Cerebral infarction due to thrombosis of bilateral cerebellar arteries
I63.349 Cerebral infarction due to thrombosis of unspecified cerebellar artery
I63.39 Cerebral infarction due to thrombosis of other cerebral artery
I63.40 Cerebral infarction due to embolism of unspecified cerebral artery
I63.411 Cerebral infarction due to embolism of right middle cerebral artery
I63.412 Cerebral infarction due to embolism of left middle cerebral artery
I63.413 Cerebral infarction due to embolism of bilateral middle cerebral arteries
I63.419 Cerebral infarction due to embolism of unspecified middle cerebral artery
I63.421 Cerebral infarction due to embolism of right anterior cerebral artery
I63.422 Cerebral infarction due to embolism of left anterior cerebral artery
I63.423 Cerebral infarction due to embolism of bilateral anterior cerebral arteries
I63.429 Cerebral infarction due to embolism of unspecified anterior cerebral artery
I63.431 Cerebral infarction due to embolism of right posterior cerebral artery
I63.432 Cerebral infarction due to embolism of left posterior cerebral artery
I63.433 Cerebral infarction due to embolism of bilateral posterior cerebral arteries
I63.439 Cerebral infarction due to embolism of unspecified posterior cerebral artery
I63.441 Cerebral infarction due to embolism of right cerebellar artery
I63.442 Cerebral infarction due to embolism of left cerebellar artery
I63.443 Cerebral infarction due to embolism of bilateral cerebellar arteries
I63.449 Cerebral infarction due to embolism of unspecified cerebellar artery
I63.49 Cerebral infarction due to embolism of other cerebral artery
I63.50 Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery
I63.511 Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery
I63.512 Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery
I63.513 Cerebral infarction due to unspecified occlusion or stenosis of bilateral middle cerebral arteries
I63.519 Cerebral infarction due to unspecified occlusion or stenosis of unspecified middle cerebral artery
I63.521 Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery
I63.522 Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery
I63.523 Cerebral infarction due to unspecified occlusion or stenosis of bilateral anterior cerebral arteries
I63.529 Cerebral infarction due to unspecified occlusion or stenosis of unspecified anterior cerebral artery
I63.531 Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery
I63.532 Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery
I63.533 Cerebral infarction due to unspecified occlusion or stenosis of bilateral posterior cerebral arteries
I63.539 Cerebral infarction due to unspecified occlusion or stenosis of unspecified posterior cerebral artery
I63.541 Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery
I63.542 Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery
I63.543 Cerebral infarction due to unspecified occlusion or stenosis of bilateral cerebellar arteries
I63.549 Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebellar artery
I63.59 Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery
I63.6 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic
I63.81 Other cerebral infarction due to occlusion or stenosis of small artery
I63.89 Other cerebral infarction
I63.9 Cerebral infarction, unspecified
I66.01 Occlusion and stenosis of right middle cerebral artery
I66.02 Occlusion and stenosis of left middle cerebral artery
I66.03 Occlusion and stenosis of bilateral middle cerebral arteries
I66.09 Occlusion and stenosis of unspecified middle cerebral artery
I66.11 Occlusion and stenosis of right anterior cerebral artery
I66.12 Occlusion and stenosis of left anterior cerebral artery
I66.13 Occlusion and stenosis of bilateral anterior cerebral arteries
I66.19 Occlusion and stenosis of unspecified anterior cerebral artery
I66.21 Occlusion and stenosis of right posterior cerebral artery
I66.22 Occlusion and stenosis of left posterior cerebral artery
I66.23 Occlusion and stenosis of bilateral posterior cerebral arteries
I66.29 Occlusion and stenosis of unspecified posterior cerebral artery
I66.3 Occlusion and stenosis of cerebellar arteries
I66.8 Occlusion and stenosis of other cerebral arteries
I66.9 Occlusion and stenosis of unspecified cerebral artery
I67.89 Other cerebrovascular disease
I69.020 Aphasia following nontraumatic subarachnoid hemorrhage
I69.021 Dysphasia following nontraumatic subarachnoid hemorrhage
I69.022 Dysarthria following nontraumatic subarachnoid hemorrhage
I69.051 Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage affecting right dominant side
I69.052 Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage affecting left dominant side
I69.053 Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage affecting right non-dominant side
I69.054 Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage affecting left non-dominant side
I69.059 Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage affecting unspecified side
I69.091 Dysphagia following nontraumatic subarachnoid hemorrhage
I69.120 Aphasia following nontraumatic intracerebral hemorrhage
I69.121 Dysphasia following nontraumatic intracerebral hemorrhage
I69.122 Dysarthria following nontraumatic intracerebral hemorrhage
I69.151 Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting right dominant side
I69.152 Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting left dominant side
I69.153 Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting right non-dominant side
I69.154 Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting left non-dominant side
I69.159 Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting unspecified side
I69.191 Dysphagia following nontraumatic intracerebral hemorrhage
I69.220 Aphasia following other nontraumatic intracranial hemorrhage
I69.221 Dysphasia following other nontraumatic intracranial hemorrhage
I69.222 Dysarthria following other nontraumatic intracranial hemorrhage
I69.251 Hemiplegia and hemiparesis following other nontraumatic intracranial hemorrhage affecting right dominant side
I69.252 Hemiplegia and hemiparesis following other nontraumatic intracranial hemorrhage affecting left dominant side
I69.253 Hemiplegia and hemiparesis following other nontraumatic intracranial hemorrhage affecting right non-dominant side
I69.254 Hemiplegia and hemiparesis following other nontraumatic intracranial hemorrhage affecting left non-dominant side
I69.259 Hemiplegia and hemiparesis following other nontraumatic intracranial hemorrhage affecting unspecified side
I69.291 Dysphagia following other nontraumatic intracranial hemorrhage
I69.320 Aphasia following cerebral infarction
I69.321 Dysphasia following cerebral infarction
I69.322 Dysarthria following cerebral infarction
I69.351 Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side
I69.352 Hemiplegia and hemiparesis following cerebral infarction affecting left dominant side
I69.353 Hemiplegia and hemiparesis following cerebral infarction affecting right non-dominant side
I69.354 Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side
I69.359 Hemiplegia and hemiparesis following cerebral infarction affecting unspecified side
I69.391 Dysphagia following cerebral infarction
I69.820 Aphasia following other cerebrovascular disease
I69.821 Dysphasia following other cerebrovascular disease
I69.822 Dysarthria following other cerebrovascular disease
I69.851 Hemiplegia and hemiparesis following other cerebrovascular disease affecting right dominant side
I69.852 Hemiplegia and hemiparesis following other cerebrovascular disease affecting left dominant side
I69.853 Hemiplegia and hemiparesis following other cerebrovascular disease affecting right non-dominant side
I69.854 Hemiplegia and hemiparesis following other cerebrovascular disease affecting left non-dominant side
I69.859 Hemiplegia and hemiparesis following other cerebrovascular disease affecting unspecified side
I69.891 Dysphagia following other cerebrovascular disease
I69.920 Aphasia following unspecified cerebrovascular disease
I69.921 Dysphasia following unspecified cerebrovascular disease
I69.922 Dysarthria following unspecified cerebrovascular disease
I69.951 Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting right dominant side
I69.952 Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting left dominant side
I69.953 Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting right non-dominant side
I69.954 Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting left non-dominant side
I69.959 Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting unspecified side
I69.991 Dysphagia following unspecified cerebrovascular disease
J05.0 Acute obstructive laryngitis [croup]
J38.00 Paralysis of vocal cords and larynx, unspecified
J38.01 Paralysis of vocal cords and larynx, unilateral
J38.02 Paralysis of vocal cords and larynx, bilateral
J38.4 Edema of larynx
J47.0 Bronchiectasis with acute lower respiratory infection
J47.1 Bronchiectasis with (acute) exacerbation
J47.9 Bronchiectasis, uncomplicated
J69.0 Pneumonitis due to inhalation of food and vomit
K20.0 Eosinophilic esophagitis
K21.9 Gastro-esophageal reflux disease without esophagitis
K22.0 Achalasia of cardia
K22.2 Esophageal obstruction
K22.3 Perforation of esophagus
K22.4 Dyskinesia of esophagus
K22.5 Diverticulum of esophagus, acquired
K94.30 Esophagostomy complications, unspecified
K94.31 Esophagostomy hemorrhage
K94.32 Esophagostomy infection
K94.33 Esophagostomy malfunction
K94.39 Other complications of esophagostomy
M33.00 Juvenile dermatomyositis, organ involvement unspecified
M33.01 Juvenile dermatomyositis with respiratory involvement
M33.02 Juvenile dermatomyositis with myopathy
M33.09 Juvenile dermatomyositis with other organ involvement
M33.10 Other dermatomyositis, organ involvement unspecified
M33.11 Other dermatomyositis with respiratory involvement
M33.12 Other dermatomyositis with myopathy
M33.19 Other dermatomyositis with other organ involvement
M33.20 Polymyositis, organ involvement unspecified
M33.21 Polymyositis with respiratory involvement
M33.22 Polymyositis with myopathy
M33.29 Polymyositis with other organ involvement
M33.90 Dermatopolymyositis, unspecified, organ involvement unspecified
M33.91 Dermatopolymyositis, unspecified with respiratory involvement
M33.92 Dermatopolymyositis, unspecified with myopathy
M33.99 Dermatopolymyositis, unspecified with other organ involvement
M34.0 Progressive systemic sclerosis
M34.1 CR(E)ST syndrome
M34.2 Systemic sclerosis induced by drug and chemical
M34.81 Systemic sclerosis with lung involvement
M34.82 Systemic sclerosis with myopathy
M34.83 Systemic sclerosis with polyneuropathy
M34.89 Other systemic sclerosis
M34.9 Systemic sclerosis, unspecified
M36.0 Dermato(poly)myositis in neoplastic disease
R13.10 Dysphagia, unspecified
R47.02 Dysphasia
R47.1 Dysarthria and anarthria
R47.81 Slurred speech
R47.89 Other speech disturbances
R47.9 Unspecified speech disturbances
R49.8 Other voice and resonance disorders
R63.30 Feeding difficulties, unspecified
R63.31 Pediatric feeding disorder, acute
R63.32 Pediatric feeding disorder, chronic
R63.39 Other feeding difficulties
R68.89 Other general symptoms and signs
S09.10XS Unspecified injury of muscle and tendon of head, sequela
S09.19XS Other specified injury of muscle and tendon of head, sequela
S09.8XXS Other specified injuries of head, sequela
S09.90XS Unspecified injury of head, sequela
S16.8XXS Other specified injury of muscle, fascia and tendon at neck level, sequela
S16.9XXS Unspecified injury of muscle, fascia and tendon at neck level, sequela
S19.80XS Other specified injuries of unspecified part of neck, sequela
S19.81XS Other specified injuries of larynx, sequela
S19.82XS Other specified injuries of cervical trachea, sequela
S19.83XS Other specified injuries of vocal cord, sequela
S19.84XS Other specified injuries of thyroid gland, sequela
S19.85XS Other specified injuries of pharynx and cervical esophagus, sequela
S19.89XS Other specified injuries of other specified part of neck, sequela
S19.9XXS Unspecified injury of neck, sequela
S29.001S Unspecified injury of muscle and tendon of front wall of thorax, sequela
S29.002S Unspecified injury of muscle and tendon of back wall of thorax, sequela
S29.009S Unspecified injury of muscle and tendon of unspecified wall of thorax, sequela
S29.091S Other injury of muscle and tendon of front wall of thorax, sequela
S29.092S Other injury of muscle and tendon of back wall of thorax, sequela
S29.099S Other injury of muscle and tendon of unspecified wall of thorax, sequela
S29.8XXS Other specified injuries of thorax, sequela
S29.9XXS Unspecified injury of thorax, sequela
T17.300A Unspecified foreign body in larynx causing asphyxiation, initial encounter
T17.308A Unspecified foreign body in larynx causing other injury, initial encounter
T17.310A Gastric contents in larynx causing asphyxiation, initial encounter
T17.318A Gastric contents in larynx causing other injury, initial encounter
T17.320A Food in larynx causing asphyxiation, initial encounter
T17.328A Food in larynx causing other injury, initial encounter
T17.390A Other foreign object in larynx causing asphyxiation, initial encounter
T17.398A Other foreign object in larynx causing other injury, initial encounter
T17.400A Unspecified foreign body in trachea causing asphyxiation, initial encounter
T17.408A Unspecified foreign body in trachea causing other injury, initial encounter
T17.410A Gastric contents in trachea causing asphyxiation, initial encounter
T17.418A Gastric contents in trachea causing other injury, initial encounter
T17.420A Food in trachea causing asphyxiation, initial encounter
T17.428A Food in trachea causing other injury, initial encounter
T17.490A Other foreign object in trachea causing asphyxiation, initial encounter
T17.498A Other foreign object in trachea causing other injury, initial encounter
T17.500A Unspecified foreign body in bronchus causing asphyxiation, initial encounter
T17.508A Unspecified foreign body in bronchus causing other injury, initial encounter
T17.510A Gastric contents in bronchus causing asphyxiation, initial encounter
T17.518A Gastric contents in bronchus causing other injury, initial encounter
T17.520A Food in bronchus causing asphyxiation, initial encounter
T17.528A Food in bronchus causing other injury, initial encounter
T17.590A Other foreign object in bronchus causing asphyxiation, initial encounter
T17.598A Other foreign object in bronchus causing other injury, initial encounter
T17.800A Unspecified foreign body in other parts of respiratory tract causing asphyxiation, initial encounter
T17.808A Unspecified foreign body in other parts of respiratory tract causing other injury, initial encounter
T17.810A Gastric contents in other parts of respiratory tract causing asphyxiation, initial encounter
T17.818A Gastric contents in other parts of respiratory tract causing other injury, initial encounter
T17.820A Food in other parts of respiratory tract causing asphyxiation, initial encounter
T17.828A Food in other parts of respiratory tract causing other injury, initial encounter
T17.890A Other foreign object in other parts of respiratory tract causing asphyxiation, initial encounter
T17.898A Other foreign object in other parts of respiratory tract causing other injury, initial encounter
T17.900A Unspecified foreign body in respiratory tract, part unspecified causing asphyxiation, initial encounter
T17.908A Unspecified foreign body in respiratory tract, part unspecified causing other injury, initial encounter
T17.910A Gastric contents in respiratory tract, part unspecified causing asphyxiation, initial encounter
T17.918A Gastric contents in respiratory tract, part unspecified causing other injury, initial encounter
T17.920A Food in respiratory tract, part unspecified causing asphyxiation, initial encounter
T17.928A Food in respiratory tract, part unspecified causing other injury, initial encounter
T17.990A Other foreign object in respiratory tract, part unspecified in causing asphyxiation, initial encounter
T17.998A Other foreign object in respiratory tract, part unspecified causing other injury, initial encounter
Z08 Encounter for follow-up examination after completed treatment for malignant neoplasm
Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Z85.21 Personal history of malignant neoplasm of larynx
Z85.22 Personal history of malignant neoplasm of nasal cavities, middle ear, and accessory sinuses
Z85.818 Personal history of malignant neoplasm of other sites of lip, oral cavity, and pharynx
Z85.819 Personal history of malignant neoplasm of unspecified site of lip, oral cavity, and pharynx
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10 Codes that Support Medical Necessity" section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
021x Skilled Nursing - Inpatient (Including Medicare Part A)
022x Skilled Nursing - Inpatient (Medicare Part B only)
023x Skilled Nursing - Outpatient
075x Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF)
085x Critical Access Hospital
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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Note: The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this article. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, for further guidance.


Code Description
032X Radiology - Diagnostic - General Classification
044X Speech-Language Pathology - General Classification
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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2021 R3

Article revised and published on 10/14/2021 effective for dates of service on and after 10/01/2021 to reflect the Annual ICD-10-CM Code Update. The following ICD-10-CM code has been deleted from the Group 2 Codes that support medical necessity: R63.3. The following ICD-10-CM codes have been added to the Group 2 codes that support medical necessity: R63.30, R63.31, R63.32 and R63.39. The reference to the Social Security Act has been added to the section related to the ‘CMS National Coverage Policy’, documentation requirements have been added to the ‘Article Guidance’ and minor formatting changes have been made throughout the article.

01/01/2020 R2

Article revised and published on 01/16/2020 effective for dates of service on and after 01/01/2020 to reflect the Annual CPT/HCPCS Code Update. The following CPT code(s) have undergone a descriptor change for either the short description or the long description. Depending on which description is used in this article, there may not be any change in how the code displays in the document: 74230. Minor formatting changes have been corrected throughout the article.

11/14/2019 R1

Article revised and published on 11/14/2019. System changes have been made to our articles in response to CMS Change Request 10901. The Coding Section has been reordered and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L35433 - Barium Swallow Studies, Modified
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
06/15/2023 10/01/2021 - 06/15/2023 Retired View
10/08/2021 10/01/2021 - N/A Superseded You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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