R63.31 — Pediatric feeding disorder, acute
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.
- Beneficiary is confined to the home to qualify for the Medicare home health PPS benefit.
- Beneficiary is under the care of a physician.
- Beneficiary is receiving services under a plan of care that is established and periodically reviewed by a physician.
- Beneficiary needs skilled nursing care on an intermittent basis, or physical therapy, or speech-language pathology, or has a continued need for occupational therapy.
- Physical therapy services ordered by a physician and provided by a qualified physical therapist or under the general supervision of a qualified physical therapist are covered when reasonable and necessary to treat illness/injury or to restore or maintain function.
6 Active Policies
A56767 — Billing and Coding: Heavy Metal Testing
J06
L35074 — Heavy Metal Testing
J06
A56621 — Billing and Coding: Swallowing Studies for Dysphagia
A57311 — Billing and Coding: Physical Therapy - Home Health
L33449 — Swallowing Studies for Dysphagia
Related Codes
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