DESCRIPTION
Videofluoroscopy is a noninvasive radiologic technique intended to assess the competency of velopharyngeal closure. Videotape recording produces a continuous record of the velopharyngeal mechanism. The procedure is used to assess various forms of velopharyngeal insufficiency, including cleft palate. A barium coating of the pharyngeal structures can be used to provide contrast in the videofluoroscopic image. Frontal and basal viewing angles can be used alone or in combination.
POLICY
Videofluoroscopic evaluation to assess the competency of velopharyngeal closure in speech pathology is considered investigational.
ADDITIONAL INFORMATION
Videofluoroscopic evaluation of velopharyngeal closure in speech pathology does not meet the following technology evaluation criteria:
The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes.
The technology must improve the net health outcome.
The technology must be as beneficial as any established alternatives.
The improvement must be attainable outside the investigational settings.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2003). Videofluoroscopic evaluation of velopharyngeal closure (6.01.15). Retrieved December 18, 2006 from BlueWeb.
Health Technology Assessment Information Service. Executive briefings. (1999, October). Diagnosis and treatment of swallowing disorders in acute-care stroke patients, Part 1: Instrumentation exams versus clinical beside exams. Retrieved May 28, 2002 from ECRI HTAIS.
The Technology Evaluation Center. (1988, March). Videofluoroscopic evaluation in speech pathology (2355HSC715TEC388). Chicago: BlueCross BlueShield Association.
Witt, P. D., Marsh, J. L., McFarland, E. G., & Riski, J. E. (2000). The evolution of velopharyngeal imaging. Annals of Plastic Surgery, 45 (6), 665-673. Abstract retrieved May 28, 2002 from PubMed database.
ORIGINAL EFFECTIVE DATE: 12/1985
MOST RECENT REVIEW DATE: 2/22/2007
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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