As of October 1, 2011, Medicare will no longer require speech-language pathologists performing videostroboscopy (CPT 31579) or nasopharyngoscopy (CPT 92511) to be supervised by physicians. The Centers for Medicare and Medicaid Services (CMS) had instituted a requirement on January 1, 2011, that a physician be in the room supervising an SLP performing the procedures. This onerous requirement, as a national Medicare policy, will be eliminated in October.
A letter from CMS Administrator Donald Berwick acknowledged that "while physicians perform these diagnostic procedures, speech pathologists also perform these procedures to evaluate and treat a patient's functional/use problems." Berwick's letter removed all supervision levels previously assigned to the procedures, effective October 1. Thus, a properly trained SLP performing videostroboscopy or nasopharyngoscopy will not need to have a physician on the premises or exercising supervision.
Because no national supervision level is established, individual Medicare administrative contractors (MACs) may establish local supervision requirements for these procedures in their speech-language pathology local coverage determinations. Moreover, it does not diminish the vital role of the otolaryngologists. Please refer to ASHA's Preferred Practice Patterns for Voice, which state in part, "All patients/clients with voice disorders are examined by a physician, preferably in a discipline appropriate to the presenting complaint…"
The CMS decision regarding videostroboscopy and nasopharyngoscopy does not affect fiberoptic endoscopic examination of swallowing (FEES) or other endoscopy procedures. Supervision levels for FEES continue to be determined by MACs.
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