Therapy for the treatment of dysphagia is considered medically necessary and proceeds for payment when any of the following criteria are met:
• Weight loss or malnutrition due to inability to obtain adequate nutrition orally, or
• History of, or being at high risk of, recurring aspirations or suffocation, or
• The patient is unable to swallow and has a nasogastric tube or gastrostomy for feeding.
Dysphagia therapy does not apply for payment for all other indications, since its effectiveness for indications other than those mentioned above has not been established.
Esophageal dilation proceeds for payment for the treatment of symptomatic obstruction of the esophagus.
Esophageal dilation for the treatment of non-obstructive esophageal dysphagia is not applicable for payment, since its efficacy has not been established.
The placement of a stent may be considered for payment in cases of refractory stenosis (it can not be dilated to an adequate diameter), such as malignant esophageal strictures.
The following interventions, but not limited to these alone, do not proceed for payment for the treatment of dysphagia because their efficacy in these indications has not been established:
• Botulinum toxin
• Electrical stimulation
• Pharyngeal motor cortex stimulation
• Repetitive transcranial magnetic stimulation
