R63.30 — Feeding difficulties, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Claims for swallowing studies should include documentation consistent with LCD L33449; this billing guideline is a complement to that LCD and providers should retain medical records supporting the medical necessity of the dysphagia evaluation.
- Verify and document compliance with applicable NCCI edits and OPPS packaging rules prior to billing.
- Include a valid ICD-10-CM diagnosis code on the claim that best describes the patient's condition for which the heavy metal test was performed.
- For diagnostic heavy metal tests, report the test result on the claim if known; if the result is not known, report the symptoms that prompted the test.
Key Coverage Criteria
- Swallowing studies (videofluoroscopic or radiologic studies described by CPT 70370, 70371, or 74230) performed for evaluation or diagnosis of dysphagia are the intended covered service per this billing guideline and LCD L33449.
- Instrumental assessment of swallowing (videofluoroscopic Modified Barium Swallow, MBS) is covered for patients with dysphagia who have documented pharyngeal dysfunction or are at risk for aspiration.
- Instrumental assessment is covered when a prior clinical (noninstrumental) swallowing examination identifies a problem that cannot be resolved without further instrumental assessment.
- Covered for patients with stroke or other central nervous system (CNS) disorders with associated speech and swallowing impairment.
- Covered for patients after surgical ablation or radiation for head and neck cancer with documented difficulty swallowing.
- Covered for patients without an obvious CNS disorder who have documented difficulty swallowing.
6 Active Policies
A56767 — Billing and Coding: Heavy Metal Testing
J06
L35074 — Heavy Metal Testing
J06
ANTHEM-CG-SURG-122 — CG-SURG-122 Lingual Frenotomy for Ankyloglossia-Related Feeding Difficulties
ANTHEM-CG-LAB-32 — CG-LAB-32 Cancer Antigen 125 Testing
A56621 — Billing and Coding: Swallowing Studies for Dysphagia
Related Codes
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