SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Swallowing Studies for Dysphagia

A56621

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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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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56621
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Swallowing Studies for Dysphagia
Article Type
Billing and Coding
Original Effective Date
06/27/2019
Revision Effective Date
10/01/2022
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 © 2024, 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, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim. 

CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 3, §3.4.1.3 Diagnosis Code Requirements

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Swallowing Studies for Dysphagia L33449.

Utilization Guidelines

CPT® codes 70370, 70371 and 74230 describe the complete procedure and should not be billed more than one time per patient on the same date of service. Only one of the above codes should be billed per patient on the same date of service.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
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. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT® descriptors in policies published on the Web.

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

(46 Codes)
Group 1 Paragraph

The CPT®/HCPCS codes included in this Billing and Coding: Swallowing Studies for Dysphagia A56621 article will be subjected to "procedure to diagnosis" editing. The following lists include only those diagnoses for which the identified CPT®/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.

I69.091, I69.191, I69.291, I69.391, I69.891, I69.991, J69.0 and the "T" codes listed in Group 1 do not require a secondary diagnosis.

Covered for:

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
T17.200D Unspecified foreign body in pharynx causing asphyxiation, subsequent encounter
T17.200S Unspecified foreign body in pharynx causing asphyxiation, sequela
T17.208D Unspecified foreign body in pharynx causing other injury, subsequent encounter
T17.208S Unspecified foreign body in pharynx causing other injury, sequela
T17.210D Gastric contents in pharynx causing asphyxiation, subsequent encounter
T17.210S Gastric contents in pharynx causing asphyxiation, sequela
T17.218D Gastric contents in pharynx causing other injury, subsequent encounter
T17.218S Gastric contents in pharynx causing other injury, sequela
T17.220D Food in pharynx causing asphyxiation, subsequent encounter
T17.220S Food in pharynx causing asphyxiation, sequela
T17.228D Food in pharynx causing other injury, subsequent encounter
T17.228S Food in pharynx causing other injury, sequela
T17.290D Other foreign object in pharynx causing asphyxiation, subsequent encounter
T17.290S Other foreign object in pharynx causing asphyxiation, sequela
T17.298D Other foreign object in pharynx causing other injury, subsequent encounter
T17.298S Other foreign object in pharynx causing other injury, sequela
T17.300D Unspecified foreign body in larynx causing asphyxiation, subsequent encounter
T17.300S Unspecified foreign body in larynx causing asphyxiation, sequela
T17.308D Unspecified foreign body in larynx causing other injury, subsequent encounter
T17.308S Unspecified foreign body in larynx causing other injury, sequela
T17.310D Gastric contents in larynx causing asphyxiation, subsequent encounter
T17.310S Gastric contents in larynx causing asphyxiation, sequela
T17.318D Gastric contents in larynx causing other injury, subsequent encounter
T17.318S Gastric contents in larynx causing other injury, sequela
T17.320D Food in larynx causing asphyxiation, subsequent encounter
T17.320S Food in larynx causing asphyxiation, sequela
T17.328D Food in larynx causing other injury, subsequent encounter
T17.328S Food in larynx causing other injury, sequela
T17.390D Other foreign object in larynx causing asphyxiation, subsequent encounter
T17.390S Other foreign object in larynx causing asphyxiation, sequela
T17.398D Other foreign object in larynx causing other injury, subsequent encounter
T17.398S Other foreign object in larynx causing other injury, sequela
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

At least one of the secondary diagnoses from Group 2 is required for *R13.X range of codes.

Medicare is establishing the following limited coverage for CPT®/HCPCS codes 70370, 70371 and 74230.

Group 2

(262 Codes)
Group 2 Paragraph

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

Group 2 Codes
Code Description
B91 Sequelae of poliomyelitis
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
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
C06.1 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
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
C49.A1 Gastrointestinal stromal tumor of esophagus
C76.0 Malignant neoplasm of head, face and neck
G12.21 Amyotrophic lateral sclerosis
G12.22 Progressive bulbar palsy
G12.23 Primary lateral sclerosis
G12.24 Familial motor neuron disease
G12.29 Other motor neuron disease
G12.8 Other spinal muscular atrophies and related syndromes
G14 Postpolio syndrome
G20 Parkinson's disease
G21.11 Neuroleptic induced 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
G35 Multiple sclerosis
G70.00 Myasthenia gravis without (acute) exacerbation
G70.01 Myasthenia gravis with (acute) exacerbation
G70.80 Lambert-Eaton syndrome, unspecified
G70.81 Lambert-Eaton syndrome in disease classified elsewhere
G71.00 Muscular dystrophy, unspecified
G71.01 Duchenne or Becker muscular dystrophy
G71.02 Facioscapulohumeral muscular dystrophy
G71.09 Other specified muscular dystrophies
G73.1 Lambert-Eaton syndrome in neoplastic disease
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
I63.013 Cerebral infarction due to thrombosis of bilateral vertebral arteries
I63.033 Cerebral infarction due to thrombosis of bilateral carotid arteries
I63.113 Cerebral infarction due to embolism of bilateral vertebral arteries
I63.133 Cerebral infarction due to embolism of bilateral carotid arteries
I63.213 Cerebral infarction due to unspecified occlusion or stenosis of bilateral vertebral arteries
I63.233 Cerebral infarction due to unspecified occlusion or stenosis of bilateral carotid arteries
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
I63.321 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
I63.331 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
I63.341 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
I63.39 Cerebral infarction due to thrombosis of other 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
I63.421 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
I63.431 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
I63.441 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
I63.49 Cerebral infarction due to embolism of other 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
I63.521 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
I63.531 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
I63.541 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
I63.59 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
I66.02 Occlusion and stenosis of left middle cerebral artery
I66.03 Occlusion and stenosis of bilateral middle cerebral arteries
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
I66.21 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
I66.3 Occlusion and stenosis of cerebellar arteries
I66.8 Occlusion and stenosis of other cerebral arteries
I67.850 Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
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
I69.122 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
I69.222 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
I69.322 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
I69.822 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
I69.922 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
K20.0 Eosinophilic esophagitis
K21.00 Gastro-esophageal reflux disease with esophagitis, without bleeding
K21.01 Gastro-esophageal reflux disease with esophagitis, with bleeding
K21.9 Gastro-esophageal reflux disease without esophagitis
K22.0 Achalasia of cardia
K22.2 Esophageal obstruction
K22.5 Diverticulum of esophagus, acquired
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
R05.1 Acute cough
R05.2 Subacute cough
R05.3 Chronic cough
R05.4 Cough syncope
R05.8 Other specified cough
R05.9 Cough, unspecified
R63.30 Feeding difficulties, unspecified
R63.31 Pediatric feeding disorder, acute
R63.32 Pediatric feeding disorder, chronic
R63.39 Other feeding difficulties
T17.200D Unspecified foreign body in pharynx causing asphyxiation, subsequent encounter
T17.200S Unspecified foreign body in pharynx causing asphyxiation, sequela
T17.208D Unspecified foreign body in pharynx causing other injury, subsequent encounter
T17.208S Unspecified foreign body in pharynx causing other injury, sequela
T17.210D Gastric contents in pharynx causing asphyxiation, subsequent encounter
T17.210S Gastric contents in pharynx causing asphyxiation, sequela
T17.218D Gastric contents in pharynx causing other injury, subsequent encounter
T17.218S Gastric contents in pharynx causing other injury, sequela
T17.220D Food in pharynx causing asphyxiation, subsequent encounter
T17.220S Food in pharynx causing asphyxiation, sequela
T17.228D Food in pharynx causing other injury, subsequent encounter
T17.228S Food in pharynx causing other injury, sequela
T17.290D Other foreign object in pharynx causing asphyxiation, subsequent encounter
T17.290S Other foreign object in pharynx causing asphyxiation, sequela
T17.298D Other foreign object in pharynx causing other injury, subsequent encounter
T17.298S Other foreign object in pharynx causing other injury, sequela
T17.300D Unspecified foreign body in larynx causing asphyxiation, subsequent encounter
T17.300S Unspecified foreign body in larynx causing asphyxiation, sequela
T17.308D Unspecified foreign body in larynx causing other injury, subsequent encounter
T17.308S Unspecified foreign body in larynx causing other injury, sequela
T17.310D Gastric contents in larynx causing asphyxiation, subsequent encounter
T17.310S Gastric contents in larynx causing asphyxiation, sequela
T17.318D Gastric contents in larynx causing other injury, subsequent encounter
T17.318S Gastric contents in larynx causing other injury, sequela
T17.320D Food in larynx causing asphyxiation, subsequent encounter
T17.320S Food in larynx causing asphyxiation, sequela
T17.328D Food in larynx causing other injury, subsequent encounter
T17.328S Food in larynx causing other injury, sequela
T17.390D Other foreign object in larynx causing asphyxiation, subsequent encounter
T17.390S Other foreign object in larynx causing asphyxiation, sequela
T17.398D Other foreign object in larynx causing other injury, subsequent encounter
T17.398S Other foreign object in larynx causing other injury, sequela
Z85.21 Personal history of malignant neoplasm of larynx
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
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

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
N/A

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.

Code Description
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

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

Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2022 R6

Under CMS National Coverage Policy updated section headings for regulations. Under ICD-10-CM Codes that Support Medical Necessity Group 2: Codes added K21.00 and K21.01.

10/01/2021 R5

Under ICD-10 Codes that Support Medical Necessity Group 2: Codes added R63.30, R63.31, R63.32 and R63.39. This revision is due to the Annual ICD-10 Update and is retroactive effective for dates of services on or after 10/1/2021.

10/01/2021 R4

Under ICD-10 Codes that are Covered Group 1: Paragraph subsection Group 1: Asterisk moved verbiage “At least one of the secondary diagnoses from Group 2 is required for *R13.X range of codes. Medicare is establishing the following limited coverage for CPT®/HCPCS codes 70370, 70371 and 74230” under Group 1: Medical Necessity ICD-10-CM Codes Asterisk Explanation. This revision will become effective on 10/1/2021.

Under ICD-10 Codes that are Covered Group 2: Codes deleted R05 and R63.3 and added R05.1, R05.2, R05.3, R05.4, R05.8 and R05.9. This revision is due to the Annual ICD-10 Update and will become effective on 10/1/2021.

01/01/2020 R3

Under CPT/HCPCS Codes Group 1: Codes the description for CPT® code 74230 was changed.

This revision is due to the 2020 Annual CPT/HCPCS Code Update and is effective on January 1, 2020.

11/14/2019 R2

This article 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 and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Swallowing Studies for Dysphagia L33449 LCD and placed in this article. Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added asterisks to the R13.X range of codes.

06/27/2019 R1 All coding located in the Coding Information section has been removed from the related Swallowing Studies for Dysphagia L33449 LCD and added to this article.
N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L33449 - Swallowing Studies for Dysphagia
Related National Coverage Documents
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SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
03/18/2024 04/15/2024 - N/A Currently in Effect View
09/05/2023 10/01/2023 - 04/14/2024 Superseded View
08/30/2022 10/01/2022 - 09/30/2023 Superseded View
07/28/2022 10/01/2022 - N/A Superseded You are here
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Keywords

  • Swallowing
  • Dysphagia