Getting Started With Flexible Endoscopic Evaluation of Swallowing (FEES)

State Licensing Regulations

Some states adhere to specific regulations for using endoscopy. These regulations might include how many times you need to practice the procedure, what documentation is required, and what supervision guidelines you must follow.

Check out ASHA’s State-by-State webpages for an overview, but it’s a good idea to contact your state licensing board directly.
Ask your state licensing board questions such as this:

“Does our practice act require a specific number of endoscope passes or physician oversight? If so, what documentation is needed?”

Employer and Manufacturer Requirements

If your state doesn’t have specific regulations for endoscopy, your workplace will likely set its own policies. Facilities typically create policies for the following areas:

procedure protocols
equipment safety
clinician competencies

Equipment manufacturers may also have recommendations, so ask their representatives for advice on guidelines and best practices.

How Clinicians Can Build Competency

ASHA doesn’t require any specialty certifications for performing FEES, but clinicians are responsible for ensuring that they are competent to perform the procedure.
Some clinicians may need more practice than others before feeling confident. For example:
- An intensive course may help you meet your state’s minimum requirements (e.g., a certain number of endoscope passes), but you might need months of practice to feel truly independent.
Consider consulting the Dysphagia Competency Verification Tool (DCVT) [PDF] for guidance on developing your skills.
Written competency plans can protect you from liability and can help you meet documentation standards for facility reviews or surveys.

Training and Equipment

There are many training programs and equipment options available, but ASHA doesn’t endorse specific ones. Here are some helpful resources to guide your decisions:

When starting a FEES program, talk with your administrators and ask:

Budget: What funds are available for training and equipment?
Equipment Cleaning: What’s our current process for cleaning equipment, and how quickly can it be ready for reuse?
Scheduling Training: How will we schedule time for training and mentorship?
Video Storage: Are there limitations with our electronic medical records (EMR) system, and how can we ensure that recordings are stored securely?

Working With an Interprofessional Team

Physician involvement may or may not be required, depending on your state’s regulations and your team’s skill level.
Even if you don’t need a physician mentor for passing a scope, it’s wise to involve medical leadership to help develop emergency protocols and procedural guidelines.
If you identify anatomical issues on FEES, ensure there’s a clear process for referring patients to the appropriate medical professionals.

Additional Resources

Here are some resources for diving deeper into FEES. Articles may require logging in using your ASHA account information:

For more help, reach out to ASHA’s Health Care Services Team at healthservices@asha.org or contact the Reimbursement Team for billing and coding questions at reimbursement@asha.org.