TL;DR: Aetna, a CVS Health company, modified CPB 0248 governing FEES, FEESST, and MBSS swallowing evaluations, effective September 26, 2025. Billing teams should audit charge capture for CPT codes 92612–92617, 92610, 92611, 74230, and 92526 before that date.
Aetna updated its FEES and FEESST coverage policy under CPB 0248 Aetna system, now providing explicit criteria for when fiberoptic endoscopic evaluation of swallowing is the preferred test over videofluoroscopy. This distinction matters for reimbursement because it directly shapes how you document medical necessity on claims. The policy covers CPT codes 92612, 92613, 92614, 92615, 92616, and 92617 for endoscopic evaluations, plus 92610, 92611, and 74230 for fluoroscopic and oral pharyngeal assessments—and it lays out specific clinical conditions that determine which test Aetna will pay for. Get your billing team aligned on these criteria before the September 26, 2025 effective date.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Fiberoptic Endoscopic Evaluation of Swallowing (FEES)/FEESST and Laryngopharyngeal Endoscopic Esthesiometer (LPEER) |
| Policy Code | CPB 0248 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Speech-Language Pathology, Otolaryngology, Neurology, Radiology, Gastroenterology, Pulmonology, ICU/Critical Care |
| Key Action | Map clinical documentation to Aetna's 10 FEES-preferred criteria and update charge capture for CPT 92612–92617 before September 26, 2025 |
Aetna FEES and FEESST Coverage Criteria and Medical Necessity Requirements 2025
The updated Aetna FEES coverage policy does something useful: it draws a clear line between when FEES is merely acceptable and when it's the preferred test. That's not a small distinction. Payers use preference language to justify denials when they believe a cheaper or simpler test would have done the job.
Aetna considers both fiberoptic endoscopy and videofluoroscopy medically necessary for evaluating swallowing function. But the policy now enumerates 10 specific clinical conditions where FEES—billed under CPT 92612 and 92613 for the procedure and physician interpretation—takes priority over videofluoroscopy.
The 10 FEES-Preferred Conditions
Aetna will recognize FEES (CPT 92612, 92613) as the preferred test over videofluoroscopy in any of the following situations:
| # | Covered Indication |
|---|---|
| 1 | Aspiration risk from barium — When a more conservative exam is required due to concerns about aspiration of barium, food, or liquid. |
| 2 | Fatigue or meal-length assessment — When you need to assess fatigue or swallowing status over the course of a full meal. |
| 3 | Repeat examination — To track change over time, assess maneuver effectiveness, or determine whether maneuvers are still needed. |
| 4 | Severe dysphagia — When the patient has a very weak or possibly absent swallow reflex, very limited tolerance for any aspiration, or conditions like brainstem stroke, prolonged tube feeding, poor pulmonary status, or compromised immune function. |
| 5 | Therapeutic examination — When the exam is being used to trial multiple maneuvers, consistencies, or positions—such as testing real foods, holding an infant in different positions, or using biofeedback. |
| 6 | Post-intubation or post-surgical laryngeal assessment — To visualize the larynx directly for trauma or neurological damage after intubation or surgery, especially coronary artery bypass grafting, carotid endarterectomy, or any procedure where the recurrent laryngeal nerve was at risk. |
| 7 | Positioning problems — When fluoroscopy positioning is not feasible because the patient is bedridden, has contractures, is in pain, has decubitus ulcers, is quadriplegic, is wearing a neck halo, is obese, or is on a ventilator. |
| 8 | Tracheostomy with suspected laryngeal compromise — When laryngeal competence may be at risk in a patient with a tracheostomy. |
| 9 | Transportation to fluoroscopy is not possible — When the patient is medically fragile or unstable in an ICU, has continuous cardiac or other monitoring in place, is on a ventilator, or requires constant nursing or medical attendance. |
| 10 | Transportation to a hospital is not possible — Nursing home patients where transportation costs, required accompaniment, physical strain, or patient anxiety about leaving familiar surroundings make hospital transport impractical. |
The real issue here is documentation. Any claim for CPT 92612 or 92613 on an Aetna member should have a clear clinical note that maps to one or more of these 10 conditions. A generic dysphagia diagnosis code alone—even a valid one like R13.10—won't protect you from a claim denial if the record doesn't explain why FEES was preferred over videofluoroscopy.
FEESST and Sensory Testing (CPT 92614–92617)
The FEESST sensory testing component—endoscopic air pulse stimulation—is covered under CPT 92614 and 92615 (sensory testing, procedure and physician interpretation) and CPT 92616 and 92617 (combined FEES and sensory testing, procedure and physician interpretation). Coverage requires that the patient has persistent dysphagia and meets the FEES criteria above. You can't bill the sensory component as a standalone path around the base FEES criteria.
Modified Barium Swallow Study (CPT 74230, 92610, 92611)
The MBSS coverage policy runs parallel to FEES. Aetna covers the modified barium swallow study—billed as CPT 74230, 92610, or 92611—when it's performed by a speech-language pathologist and radiologist together, dysphagia has already been diagnosed, and at least one of these conditions applies:
| # | Covered Indication |
|---|---|
| 1 | Clinical swallow evaluation shows aspiration risk |
| 2 | Follow-up of a known swallowing disorder |
| 3 | Need to determine appropriate diet level or liquid consistency |
| 4 | Need to assess the effectiveness of swallowing postures, maneuvers, or strategies |
This is worth noting for practices that bill MBSS and FEES together or in sequence. Aetna's policy covers both modalities—but each requires its own documented medical necessity basis.
Prior Authorization
The policy doesn't specify a blanket prior authorization requirement for these codes, but prior auth requirements vary by plan. Check Aetna member-specific plan details before scheduling. Post-intubation cases and ICU patients in particular may trigger utilization management review. If you're not sure what applies to your patient mix, talk to your compliance officer before the September 26, 2025 effective date.
Aetna FEES and FEESST Exclusions and Non-Covered Indications
The Laryngopharyngeal Endoscopic Esthesiometer (LPEER) appears in the policy title but is not listed in the covered criteria or the code table. The policy title names it; the clinical criteria and billing guidelines don't support it as a separately billable service under CPB 0248. Don't bill for LPEER as a distinct service under this policy. If you're using LPEER technology as part of a FEESST procedure, it falls under the FEESST framework—not as an independent covered service.
There are no separate experimental or investigational designations listed for the covered CPT codes in this policy update. If Aetna considers a specific application experimental, it would appear in a separate technology assessment. Nothing in CPB 0248 as modified designates 92612–92617 or related codes as experimental.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| FEES for evaluation of swallowing function (general) | Covered | 92612, 92613 | Must meet at least one of 10 FEES-preferred criteria |
| FEES preferred over videofluoroscopy — aspiration risk from barium | Covered / Preferred | 92612, 92613 | Document barium aspiration concern in clinical notes |
| FEES preferred — fatigue or meal-length assessment | Covered / Preferred | 92612, 92613 | Document need to assess full-meal swallowing status |
| FEES preferred — repeat exam for maneuver effectiveness | Covered / Preferred | 92612, 92613 | Document prior FEES or videofluoroscopy history |
| FEES preferred — severe dysphagia (brainstem stroke, tube-fed, poor pulmonary/immune status) | Covered / Preferred | 92612, 92613 | Map to ICD-10 R13.1x, I69.x91, or relevant diagnosis |
| FEES preferred — therapeutic exam (trialing maneuvers, consistencies, positions) | Covered / Preferred | 92612, 92613 | Document therapeutic intent in clinical note |
| FEES preferred — post-intubation or post-surgical laryngeal assessment (CABG, carotid endarterectomy, recurrent laryngeal nerve risk) | Covered / Preferred | 92612, 92613 | Specific mention of recurrent laryngeal nerve vulnerability |
| FEES preferred — positioning problems (bedridden, contractures, ventilator, quadriplegic, etc.) | Covered / Preferred | 92612, 92613 | Document specific positioning barrier |
| FEES preferred — tracheostomy with suspected laryngeal compromise | Covered / Preferred | 92612, 92613 | Document tracheostomy status and laryngeal concern |
| FEES preferred — transportation to fluoroscopy not feasible (ICU, ventilator, continuous monitoring) | Covered / Preferred | 92612, 92613 | Document transport barrier with clinical rationale |
| FEES preferred — transportation to hospital not feasible (nursing home, cost, patient distress) | Covered / Preferred | 92612, 92613 | Document transportation barrier clearly |
| FEESST sensory testing component | Covered | 92614, 92615, 92616, 92617 | Requires persistent dysphagia AND FEES criteria above |
| Modified barium swallow study (MBSS) | Covered | 74230, 92610, 92611 | Requires SLP + radiologist; dysphagia diagnosed; one of four MBSS criteria met |
| MBSS — aspiration risk identified on clinical swallow eval | Covered | 74230, 92610, 92611 | Document clinical swallow evaluation findings |
| MBSS — follow-up of known swallowing disorder | Covered | 74230, 92610, 92611 | Document prior diagnosis |
| MBSS — diet level or liquid consistency determination | Covered | 74230, 92610, 92611 | Document dietary assessment need |
| MBSS — assess effectiveness of postures, maneuvers, or strategies | Covered | 74230, 92610, 92611 | Document therapeutic rationale |
| Treatment of swallowing dysfunction | Related (not under CPB 0248 coverage criteria) | 92526 | Listed as related code; coverage governed separately |
| LPEER as a standalone service | Not supported under CPB 0248 | — | Not listed in covered criteria or code table |
Aetna FEES and FEESST Billing Guidelines and Action Items 2025
These are the specific steps your billing team should take before the September 26, 2025 effective date.
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for CPT 92612–92617 on all Aetna claims. Pull the last 90 days of claims for these codes and check whether the corresponding clinical documentation maps to one of Aetna's 10 FEES-preferred criteria. If it doesn't, you have a denial risk starting September 26, 2025. |
| 2 | Update clinical documentation templates for FEES cases. Work with your SLP and ENT teams to build a structured note field that explicitly addresses the applicable FEES-preferred condition. "Patient is tube-fed and has severely impaired swallow reflex consistent with brainstem stroke" is defensible. "FEES performed for dysphagia evaluation" is not—at least not alone. |
| 3 | Separate FEESST billing into component codes when appropriate. If you're performing combined FEES and sensory testing, bill CPT 92616 and 92617 (combined procedure and interpretation). If you're billing sensory testing separately, use 92614 and 92615. Make sure the claim reflects what was actually performed and that the documentation supports persistent dysphagia plus FEES criteria. |
| 4 | Confirm SLP and radiologist co-performance documentation for all MBSS claims. Aetna's coverage policy for CPT 74230, 92610, and 92611 requires both a speech-language pathologist and a radiologist. If your MBSS claims don't show both providers involved, update your billing workflow now. |
| 5 | Verify ICD-10 specificity on all FEES and FEESST claims. Generic R13.10 (dysphagia, unspecified) won't carry the claim if the clinical record points to a more specific condition. Use the most specific applicable code from the 66-code list—R13.11–R13.19, I69.091 or other cerebrovascular sequelae codes, J69.0 for aspiration pneumonitis, or the relevant neurological or esophageal diagnosis. |
| 6 | Check plan-level prior authorization requirements before scheduling. The policy itself doesn't mandate prior auth universally, but Aetna plan variations do. This is especially true for ICU patients, post-surgical cases, and nursing home patients who meet the transportation criteria. Confirm prior auth status on each member before the study. |
| 7 | Don't bill 92526 under CPB 0248 coverage criteria. CPT 92526 (treatment of swallowing dysfunction) is listed as a related code, not a covered code under the selection criteria here. Its reimbursement is governed by separate policy. Mixing it into FEES/FEESST claim lines creates confusion and potential audit exposure. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for FEES and FEESST Under CPB 0248
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 74230 | CPT | Swallowing function, with cineradiography/videoradiography (including modified barium swallowing study) |
| 92610 | CPT | Evaluation of oral and pharyngeal swallowing function |
| 92611 | CPT | Motion fluoroscopic evaluation of swallowing function by cine or video recording |
| 92612 | CPT | Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording |
| 92613 | CPT | Physician interpretation and report only (for 92612) |
| 92614 | CPT | Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording |
| 92615 | CPT | Physician interpretation and report only (for 92614) |
| 92616 | CPT | Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording |
| 92617 | CPT | Physician interpretation and report only (for 92616) |
Key ICD-10-CM Diagnosis Codes
| Code | Description |
|---|---|
| G45.0–G45.9 | Transient cerebral ischemic attack (multiple subcategory codes) |
| I65.01–I67.9 | Occlusion and stenosis of precerebral arteries, occlusion of cerebral arteries, and acute but ill-defined cerebrovascular disease |
| I69.091 | Dysphagia following unspecified cerebrovascular disease |
| I69.191 | Dysphagia following nontraumatic intracerebral hemorrhage |
| I69.291 | Dysphagia following other nontraumatic intracranial hemorrhage |
| I69.391 | Dysphagia following cerebral infarction |
| I69.891 | Dysphagia following other cerebrovascular disease |
| I69.991 | Dysphagia following unspecified cerebrovascular disease |
| J38.7 | Other diseases of larynx |
| J69.0 | Pneumonitis due to inhalation of food and vomit (aspiration pneumonitis) |
| K21.0–K21.9 | Gastro-esophageal reflux disease (multiple subcategory codes) |
| K22.0 | Achalasia of cardia |
| K22.4 | Dyskinesia of esophagus |
| K22.81–K22.89 | Other specified diseases of esophagus |
| K23 | Disorders of esophagus in diseases classified elsewhere |
| Q31.0–Q32.4 | Congenital malformations of larynx, trachea, and bronchus |
| R13.10–R13.19 | Dysphagia (unspecified and subcategory-specific codes) |
| R40.0–R40.4 | Somnolence, stupor, and coma |
| R63.30–R63.39 | Feeding difficulties |
| Z13.810 | Encounter for screening for upper gastrointestinal disorder (screening for aspiration) |
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