Local Coverage Determination (LCD)

Home Health-Surface Electrical Stimulation in the Treatment of Dysphagia

L34565

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Proposed LCD
Proposed LCDs are works in progress that are available on the Medicare Coverage Database site for public review. Proposed LCDs are not necessarily a reflection of the current policies or practices of the contractor.

Document Note

Note History

Contractor Information

LCD Information

Document Information

Source LCD ID
N/A
LCD ID
L34565
Original ICD-9 LCD ID
Not Applicable
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 11/30/2023
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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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.

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Issue

Issue Description

This LCD outlines noncoverage for this service with specific details under Coverage Indications, Limitations and/or Medical Necessity.

Issue - Explanation of Change Between Proposed LCD and Final LCD

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 Medical Review of Home Health Services, §6.2.1 Physician Certification of Patient Eligibility for the Medicare Home Health Benefit, §6.2.1.1 Certification Requirements, §6.2.2 Physician Recertification, §6.2.2.1 Recertification Elements, §6.2.3 The Use of the Patient's Medical Record Documentation to Support the Home Health Certification, §6.2.5 Medical Necessity of Services Provided, and §6.2.6 Examples of Sufficient Documentation Incorporated Into a Physician's Medical Record

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 HHH Medicare Administrative Contractor (MAC).

Summary of Evidence

N/A

Analysis of Evidence (Rationale for Determination)

N/A

Proposed Process Information

Synopsis of Changes
Changes Fields Changed
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Associated Information
Sources of Information
Bibliography
Open Meetings
Meeting Date Meeting States Meeting Information
N/A
Contractor Advisory Committee (CAC) Meetings
Meeting Date Meeting States Meeting Information
N/A
MAC Meeting Information URLs
N/A
Proposed LCD Posting Date
Comment Period Start Date
Comment Period End Date
Reason for Proposed LCD
Requestor Information
This request was MAC initiated.
Requestor Name Requestor Letter
View Letter
N/A
Contact for Comments on Proposed LCD

Coding Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

CPT/HCPCS Codes

Please accept the License to see the codes.

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph:

N/A

Group 1 Codes:

N/A

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

Additional ICD-10 Information

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/recertification:

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 recertification) will not be covered, even if the requirements for recertifications are met. Recertifications 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 HHH MAC upon request.

Sources of Information
N/A
Bibliography

Blumenfeld L, Hahn Y, LePage A, Leonard R, Belafsky PC. Transcutaneous electrical stimulation versus traditional dysphagia therapy: A nonconcurrent 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. J Neurophysiol. 2005;94(6):4011-4018.

Chaudhuri G, Brady S, Caldwell R. Electric stimulation for dysphagia following stroke: Pilot data. Arch Phys Med Rehabil. 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 electric stimulation on swallow function in patient with polymyositis: A case report. Arch Phys Med Rehabil. 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. J 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. 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 rehabilitation swallowing therapy vs. neuromuscular electrical stimulation therapy among stroke patients with persistent pharyngeal dysphagia: A randomized controlled study. J Med Assoc Thai. 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? Ann Otol Rhinol Laryngol Suppl. 2007;116(1):36–44.

 

Revision History Information

Revision History Date Revision History Number Revision History Explanation Reasons for Change
11/30/2023 R11

Under CMS National Coverage Policy section headings were updated for regulations. Under Bibliography changes were made to citations to reflect AMA citation guidelines. Formatting and punctuation errors were corrected throughout the LCD.

  • Provider Education/Guidance
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 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
  • 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)
N/A

Associated Documents

Attachments
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Related National Coverage Documents
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Public Versions
Updated On Effective Dates Status
11/21/2023 11/30/2023 - N/A Currently in Effect You are here
11/15/2019 10/31/2019 - 11/29/2023 Superseded View
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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