Page 223 - Medicare Benefit Policy Manual

Assessment for the need for rehabilitation of the auditory system (but not the vestibular
system) may be done by a speech language pathologist. Examples include but are not
limited to: evaluation of comprehension and production of language in oral, signed or
written modalities, speech and voice production, listening skills, speech reading,
communications strategies, and the impact of the hearing loss on the patient/client and
family.

Examples of rehabilitation include but are not limited to treatment that focuses on
comprehension, and production of language in oral, signed or written modalities; speech
and voice production, auditory training, speech reading, multimodal (e.g., visual,
auditory-visual, and tactile) training, communication strategies, education and
counseling. In determining the necessity for treatment, the beneficiary’s performance in
both clinical and natural environment should be considered.

4. Dysphagia

Dysphagia, or difficulty in swallowing, can cause food to enter the airway, resulting in
coughing, choking, pulmonary problems, aspiration or inadequate nutrition and hydration
with resultant weight loss, failure to thrive, pneumonia and death. It is most often due to
complex neurological and/or structural impairments including head and neck trauma,
cerebrovascular accident, neuromuscular degenerative diseases, head and neck cancer,
dementias, and encephalopathies. For these reasons, it is important that only qualified
professionals with specific training and experience in this disorder provide evaluation and
treatment.

The speech-language pathologist performs clinical and instrumental assessments and
analyzes and integrates the diagnostic information to determine candidacy for
intervention as well as appropriate compensations and rehabilitative therapy techniques.
The equipment that is used in the examination may be fixed, mobile or portable.
Professional guidelines recommend that the service be provided in a team setting with a
physician/NPP who provides supervision of the radiological examination and
interpretation of medical conditions revealed in it.

Swallowing assessment and rehabilitation are highly specialized services. The
professional rendering care must have education, experience and demonstrated
competencies. Competencies include but are not limited to: identifying abnormal upper
aerodigestive tract structure and function; conducting an oral, pharyngeal, laryngeal and
respiratory function examination as it relates to the functional assessment of swallowing;
recommending methods of oral intake and risk precautions; and developing a treatment
plan employing appropriate compensations and therapy techniques.

230.4 - Services Furnished by a Therapist in Private Practice (TPP)
(Rev. 179, Issued: 01-14-14, Effective: 01-07-14, Implementation: 01-07-14)

A. General