Dysphagia Treatment with Electrical Stimulation: Coding and Coverage Considerations

ASHA is strongly committed to evidence-based practice and urges members to consider the best available evidence before utilizing any product or technique. ASHA does not endorse any products, procedures, or programs and therefore does not have an official position on the use of electrical stimulation. ASHA has developed Questions to Ask When Evaluating Any Treatment Procedure, Product, or Program to help clinicians evaluate and make informed decisions about new programs, products, or techniques.

Some speech-language pathologists (SLPs) provide electrical stimulation (e-stim) for their patients with dysphagia and have asked for guidance about coding. Some payers cover this technique while others have stated that the procedure is experimental and that they are waiting for more research. Each Medicare carrier and intermediary is given the latitude to determine coverage status.

There are three Current Procedure Codes (CPT ^© AMA) for consideration when performing e-stim. This page explains the issues and options available and was prepared to clarify issues that speech-language pathologists may have related to billing for e-stim services.

CPT 92526 (dysphagia treatment session) is not time-based and may be billed only once per day. Please note that some payers have ruled that only 92526 can be billed for services that address goals in the dysphagia treatment plan. At least five multi-state Medicare intermediaries [*] have ruled that while payment is allowed only for non-e-stim methods of treatment, e-stim treatment can also be used. For payment under 92526, the record must document the provision of non-e-stim treatment.

CPT 97032 (electrical stimulation-manual-each 15 minutes) Medicare does not accept claims for 97032 and 92526 on the same day by speech-language pathologists (see CPT 92526 + CPT 97032 below). For private health plans that accept this code, CPT 97032 is for face-to-face treatment time; the practitioner cannot be attending other patients. If, during the course of treatment, the practitioner attends other patients, the clock stops until he/she returns to the patient. Medicare allows a 15 minute code to be billed for direct treatment time of 8 to 23 minutes.

CPT 92526 + CPT 97032: Medicare Correct Coding Initiative (CCI) edits automatically deny payment of CPT 97032 when billed on the same day as CPT 92526 and performed by speech-language pathologists. CMS rejected arguments that 92526 and 97032 should be billed on the same day, stating that the former is an umbrella code for services performed to meet dysphagia treatment goals.

Private health plans may allow this pair to be billed on the same day if CPT 92526 represents treatment time that is distinct from CPT 97032 and the medical record indicates that CPT 92526 is comprised of treatment techniques not administered during e-stim. Treatment techniques common to attended electrical stimulation are cueing, feeding and tactile stimulation. Techniques that may be distinct from e-stim are:

• Proper head and body positioning
• Diet modifications
• Exercises for improving oral-motor function
• Sensory stimulation (taste, temperature, texture)
• Swallowing maneuvers (supraglottic swallow, Mendelsohn maneuver, etc.)

CPT 97014 is "electrical stimulation (unattended)." This untimed code is not appropriate for dysphagia treatment if the SLP must be present to activate electrical stimulation at the appropriate moment. Incidentally, Medicare providers must convert this 97014 to G0283, "electrical stimulation, other than wound (unattended)."

**ASHA does not endorse any specific treatment products or techniques.**

For further information regarding these coding and payment issues, contact Mark Kander at ASHA (800-498-2071, ext.4139) or mkander@asha.org . For information regarding clinical issues, contact Amy Hasselkus (800-498-2071, ext. 4514) or ahasselkus@asha.org .