Your questions about Dysphagia Treatment and Diagnostics, Mobile FEES, Swallowing Disorders, and Medicare Billing … answered!

For Professionals:

What is FEES?
  • FEES = Flexible Endoscopic Evaluation of Swallow
  •  Video imaging to determine cause and severity of swallowing impairment & used daily in hospitals to assess swallow at bedside
  • Involves a tiny camera being placed in the nose to view inside of throat and vocal folds (easily tolerated by 99.9% of people)
  • Determines if a modified diet is necessary (pureed, thickened liquids), cause of aspiration, throat strictures, nodules, inflammation or excess secretions
  • Can be brought to residents in the familiar comfort of their own environment
What is the benefit of using FEES vs MBSS?
FEES is an endoscopic assessment that is portable and can be brought to your facility at the resident’s bedside with no radiation and no barium.

  • MBSS is provided in an outpatient hospital setting, uses radiation, barium coated food/drink, primarily detects boney structures/movement and requires transportation out of facility.

FEES shows real tissue including inflammation, nodules, strictures, airway protection,  secretions pooling, inadequate vocal fold closure or paralysis, etc.


  • FEES is a simple procedure, easily tolerated with low to no risk for complications. [Reference]
  • FEES can be completed during a resident’s entire meal if needed and is not limited to 1-2 swallows due to radiation limits.
Who should I refer for a mobile FEES assessment?
Any resident  exhibiting swallowing difficulty will benefit–especially people with the following…

  • Swallowing or choking difficulty
  • Recurrent pneumonia
  • Too medically compromised or weak for transport out to hospital
  • Requires hoyer lift or max assist to transfer out of bed or wheelchair
  • Morbid obesity
  • Isolation due to infectious health condition
  • Dementia or cognitive confusion (need familiar surroundings and care partners)
  • Caregiver not available to accompany resident to outpatient hospital
Who needs to be present for the FEES appointment?
  • Facility nurse or caregiver familiar with resident is highly beneficial
  • We require a nurse to be in the building if not present at the appointment
  • Facility SLP is encouraged to attend and may bill for CPT 92526
  • Family members are always welcome and encouraged to attend
What is the cost to my facility and the resident? How is it billed?
  • Mobile FEES is covered by Medicare and almost all private insurances
  • Insight Swallow is a therapy service and must follow Medicare consolidated billing rules
  • The facility pays Insight Swallow directly (a one-time flat charge with no hidden costs)
  • Med B facility can be reimbursed for Med B residents by billing for CPT code 92612
  • Med A facility typically spends significantly less overall for Med A residents paying the one-time flat charge for mobile FEES due to reducing recurrent pneumonia, re-hospitalization, modified diet/thickener costs, etc.

For Residents & Families:

What is Dysphagia and how do you pronounce it?
  • “Dys-fa–ja”
  • The medical term for swallowing difficulty typically caused by medical conditions such as stroke, brain injury, Parkinson’s, MS, ALS, mouth/throat cancer, reflux, esophagus issues or even normal aging.
  • Dysphagia may cause serious health issues including aspiration pneumonia, which can be life threatening, weight loss, dehydration, choking and often results in being placed on pureed foods and thickened liquids.
What are the symptoms of Dysphagia?
  • Coughing or choking during or right after eating/drinking
  • Clearing throat during or right after eating/drinking
  • Weakness or difficulty chewing
  • Wet or gurgly sounding voice during or after eating/drinking
  • Excessive secretions or saliva
  • Recurrent pneumonia
  • Food/liquids coming out of the nose
  • Complaints of food “sticking” or “fullness” in throat
  • Unexplained weight loss or dehydration; avoiding certain foods
Is the FEES procedure safe? Is it painful?
  • FEES is safe and well-tolerated
  • In a study of 500  people, 99% of the participants reported they would be willing to do a repeat exam and 82% of the participants rated their discomfort level at none to mild.
  • People should never feel pain, but sometimes describe FEES as weird, ticklish or uncomfortable. [Reference]  
  • The endoscope is a small, flexible, lubricated tube with a tiny camera, easily passed through the nasal cavity.  
  • The resident is in charge! If a resident is not tolerating the procedure, the speech pathologist will listen compassionately, make adjustments, and if needed, end the procedure.  
What can I expect during a swallow imaging exam?
  • A soft, flexible endoscope is passed through the nasal cavity into the throat to view swallow structures and movement, airway protection, vocal folds, and potential tissue abnormalities/swelling/nodules.  
  • Most assessments take 15-20 minutes with resident eating/drinking a snack.
Can family members attend a FEES appointment?
  • YES!  We encourage family to be present to provide added support to resident and information to our speech pathologist.  Our therapist will teach and answer any questions or concerns throughout the assessment.
  • Facility speech pathologist is also encouraged to attend.