To get paid for a modified barium swallow (MBS), sometimes termed a videofluoroscopic swallowing study (VFSS), you have to code it correctly with CPT and ICD-10-CM codes. The major CPT code for the Modified Barium Swallow is 92611 for the instrumental swallowing evaluation by the speech language pathologist. CPT 74230 is the radiologic swallowing test.
Provider documentation should support the diagnosis code(s). Common ICD-10-CM codes include R13.10 (dysphagia, unspecified), R13.11 (oral phase), R13.12 (oropharyngeal), R13.13 (pharyngeal), R13.14 (pharyngoesophageal), and R13.19 (other dysphagia). Some illnesses such as dysphagia after stroke may need other or additional classification.
This 2026 MBS billing and coding guide outlines details of important CPT and ICD-10-CM codes, documentation criteria, medical necessity, NCCI considerations, frequent billing mistakes and helpful advice for correct claims and fewer denials.
What Is the Modified Barium Swallow CPT Code?
The primary CPT code associated with the SLP’s participation in a modified barium swallow or videofluoroscopic swallowing study is CPT 92611.
CPT 92611 represents the SLP’s instrumental evaluation of swallowing using fluoroscopic cine or video recording. ASHA identifies 92611 specifically as the code for the SLP component of an MBS/VFSS.
The radiology component is different. CPT 74230 is associated with the radiographic examination of swallowing function using videography/cineradiography. The distinction matters because an MBS is frequently performed as a collaborative service involving an SLP and radiologist.
Key MBS-related CPT codes
| Service or scenario | CPT code | Billing purpose |
|---|---|---|
| Modified barium swallow/VFSS — SLP component | 92611 | Reports the SLP’s instrumental evaluation of swallowing |
| Radiologic swallowing examination | 74230 | Reports the radiology component of the swallowing study |
| Clinical swallowing evaluation | 92610 | Evaluation of oral/pharyngeal swallowing function without the MBS/VFSS procedure itself |
| FEES | 92612 | Flexible endoscopic evaluation of swallowing with cine/video recording |
| Swallowing treatment | 92526 | Treatment addressing feeding and/or swallowing function |
| Laryngeal sensory testing | 92614 | Separate service involving laryngoscopic sensory testing when applicable |
| Associated laryngeal sensory interpretation/service codes | 92616 | Used for the applicable laryngeal sensory testing service structure |
ASHA’s reimbursement guidance identifies 92610 as the clinical swallowing evaluation, 92611 as the MBS/VFSS SLP service, and 92612 as the FEES procedure.
The important point for billing teams is that the fact that several swallowing-related CPT codes appear in the same patient’s record does not mean all of them should be reported on the same claim or same date of service. The code must correspond to the service actually performed, by the reporting provider, and under the applicable payer’s rules.
2026 Coding and Billing Rules for Modified Barium Swallow Studies
There are two different timing considerations for 2026 claims: the CPT code set and the ICD-10-CM code set.
CPT is updated annually on a calendar-year basis, while ICD-10-CM follows the federal fiscal-year cycle. For ICD-10-CM, FY 2026 generally applies to services from October 1, 2025, through September 30, 2026. CDC also issued an April 1, 2026 ICD-10-CM update that applies from April 1 through September 30, 2026.
Therefore, a billing department working on a 2026 MBS claim should not simply rely on a code list saved from a previous year.
The appropriate workflow is:
- Confirm the date of service.
- Confirm the applicable CPT edition.
- Confirm the applicable ICD-10-CM fiscal-year release.
- Review the current Medicare NCCI edits if Medicare is involved.
- Review the patient’s payer-specific medical-necessity and billing policies.
- Confirm that the documentation supports both the procedure and diagnosis codes.
CMS updates Medicare NCCI files quarterly. The current 2026 Medicare NCCI materials include files effective July 1, 2026, and CMS states that NCCI PTP edits are updated quarterly.
For Medicare payment information, CMS’s Physician Fee Schedule Look-Up Tool and 2026 payment files should be used rather than relying on an old reimbursement amount. Payment can vary by locality and other Medicare payment factors.
Master Reference: MBS CPT and ICD-10-CM Codes
CPT codes commonly encountered with MBS and dysphagia
| CPT | Service/scenario | Practical billing use |
| 92610 | Clinical swallowing evaluation | Used for the clinical evaluation of oral/pharyngeal swallowing function |
| 92611 | Videofluoroscopic swallowing evaluation | Common Modified Barium Swallow CPT code for the SLP component |
| 74230 | Radiologic swallowing examination | Radiology component of the MBS/VFSS |
| 92612 | FEES | Endoscopic swallowing evaluation, not an MBS |
| 92526 | Swallowing/feeding treatment | Treatment rather than instrumental diagnostic evaluation |
| 92614 | Laryngoscopic sensory testing | Separate procedure when the applicable service is actually performed |
| 92616 | Related laryngeal sensory testing service | Use only when the documented service meets the code requirements |
ASHA’s Medicare coding guidance specifically explains that 92611 reflects the SLP’s work during the MBS, while 74230 represents the radiologist’s participation.
ICD-10-CM dysphagia codes
| Diagnosis | ICD-10-CM code | When documentation supports it |
| Aphagia | R13.0 | Inability to swallow |
| Dysphagia, unspecified | R13.10 | Dysphagia documented but no more specific phase/type is established |
| Oral phase dysphagia | R13.11 | Documentation identifies oral-phase impairment |
| Oropharyngeal dysphagia | R13.12 | Documentation identifies oropharyngeal dysphagia |
| Pharyngeal phase dysphagia | R13.13 | Documentation identifies pharyngeal-phase dysphagia |
| Pharyngoesophageal phase dysphagia | R13.14 | Documentation identifies the pharyngoesophageal phase |
| Other dysphagia | R13.19 | A documented type of dysphagia is present but does not fit another listed category |
The FY 2026 CDC ICD-10-CM Index confirms the R13 dysphagia family and the phase-specific codes above.
Do not select R13.12 simply because an MBS was performed. The procedure does not itself establish the diagnosis code. The diagnosis must be supported by the medical record and applicable coding rules.
Dysphagia associated with cerebrovascular disease
When dysphagia is documented as a sequela of a cerebrovascular condition, an I69.- code may be applicable instead of simply assigning an R13 symptom code. The FY 2026 ICD-10-CM Index specifically identifies examples such as:
- I69.091 — dysphagia following nontraumatic subarachnoid hemorrhage
- 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
The correct code depends on the documented cerebrovascular condition and the applicable Tabular List instructions.
These codes illustrate why the diagnosis portion of an MBS claim cannot be reduced to “use R13.10.” The patient’s documented etiology and clinical history can materially change coding.
1. Start with the actual service performed
First determine whether the encounter involved:
- A bedside/clinical swallowing evaluation
- An MBS/VFSS
- FEES
- Swallowing treatment
- Radiologic interpretation
- More than one distinct service
Do not use 92611 merely because dysphagia was discussed during a routine evaluation.
If an MBS/VFSS was actually performed and the SLP provided the service represented by 92611, that is the CPT code to evaluate for the SLP portion.
2. Identify who performed each component
MBS/VFSS frequently involves multiple professionals.
The SLP’s service and the radiologist’s service are not necessarily represented by the same CPT code. ASHA identifies 92611 for the SLP component and 74230 for the radiology component.
The billing entity should therefore establish:
- Who performed the SLP evaluation?
- Who performed or interpreted the radiologic portion?
- Which provider is submitting the claim?
- Is the service being billed globally or professionally/technically under the applicable setting and payer rules?
- Does the payer recognize separate reporting for the involved components?
3. Confirm the diagnosis documented before the study
The referral or clinical documentation may identify dysphagia, aspiration concerns, neurologic disease, head and neck cancer, stroke sequelae, or another reason for the study.
The coder should code from the provider’s documentation rather than independently diagnosing the patient from fluoroscopic findings.
For example, if the MBS demonstrates impaired airway protection but the provider documentation does not establish a separate diagnosis, the coder should not automatically manufacture an additional disease code.
4. Select the most specific supported ICD-10-CM diagnosis
If the provider documents “oropharyngeal dysphagia,” R13.12 is more specific than R13.10.
If documentation says only “difficulty swallowing,” an unspecified code may be appropriate if no additional specificity is supported.
ASHA explains that unspecified codes are intended for situations in which the record does not contain sufficient information for a more specific code.
5. Determine whether an underlying condition changes the coding
Dysphagia may occur with neurologic disorders, stroke sequelae, structural conditions, malignancy, neuromuscular disease, or other conditions.
The coder should review whether the documentation establishes a relationship between the dysphagia and another disease.
The key distinction is between:
“Patient has a history of stroke and also has dysphagia”
and
“Dysphagia following cerebral infarction.”
The second statement establishes a documented relationship that can affect ICD-10-CM selection.
6. Check the ICD-10-CM Index and Tabular List
Do not rely solely on an electronic search result.
CDC’s ICD-10-CM Browser provides access to the Index, Tabular List, instructional notes, and fiscal-year-specific code information.
This is particularly important when a code has:
- Excludes notes
- Code-first instructions
- Use-additional-code instructions
- Combination-code requirements
- Sequela relationships
- Other sequencing instructions
7. Review NCCI and payer rules
Medicare NCCI edits are designed to prevent inappropriate payment when services should not be reported together. CMS explains that PTP edits can cause one code in an edit pair to deny unless an appropriate modifier is permitted and correctly used.
NCCI is not the same as medical necessity. CMS explicitly states that NCCI edits are correct-coding edits and do not perform medical-necessity review.
Therefore, a clean NCCI result does not guarantee payment.
8. Confirm medical necessity
A payer may require the diagnosis, clinical indication, referral, documentation, or other information to support why an instrumental swallowing study was necessary.
A correct CPT code with an unsupported diagnosis can still result in a denial.
Modified Barium Swallow Documentation Checklist
Documentation should make it possible for a reviewer to understand why the study was performed, what service was provided, who provided it, and what diagnosis is being treated or evaluated.
| Documentation item | Why it matters |
| Clinical indication | Establishes why instrumental evaluation was needed |
| Documented swallowing problem/diagnosis | Supports diagnosis coding |
| Specific dysphagia type or phase | May support a more specific R13 code |
| Relevant underlying disease | May affect diagnosis selection and sequencing |
| Relationship between disease and dysphagia | Important when an etiologic/sequela code is applicable |
| MBS/VFSS performed | Supports selection of 92611 when the SLP service meets its requirements |
| SLP participation and findings | Establishes the SLP service |
| Radiology participation/report | Supports the appropriate radiology billing component |
| Clinical interpretation/recommendations | Helps demonstrate the purpose and value of the study |
| Date of service | Determines applicable code-set and payer rules |
High-Risk MBS Coding and Billing Scenarios
1. Billing 92610 instead of 92611
When it happens:
A patient receives an instrumental MBS, but the claim is submitted with the code for a clinical swallowing evaluation.
Why it matters:
92610 and 92611 describe different services. ASHA identifies 92610 as the clinical swallowing evaluation and 92611 as the SLP’s MBS/VFSS service.
Correct approach:
Review the actual service and documentation before selecting the CPT code.
2. Treating 74230 and 92611 as duplicate codes
An MBS can involve both an SLP and radiologist, and the two codes represent different professional work. However, that does not mean the same provider should automatically report both codes.
ASHA explains the distinction between the SLP’s 92611 service and the radiologist’s 74230 service.
Example
A hospital-based MBS is performed with an SLP and radiologist.
Possible reporting structure:
- 92611 — SLP’s qualifying MBS/VFSS service
- 74230 — applicable radiology service
The billing entities, provider roles, payer rules, and NCCI edits must be reviewed before submission.
3. Ignoring NCCI edits
CMS maintains Medicare NCCI PTP and MUE files and updates them quarterly.
A claim scrubber should therefore use the NCCI version applicable to the date of service rather than a static edit file.
4. Using R13.10 when R13.12 is documented
If the provider documents oropharyngeal dysphagia, selecting unspecified dysphagia reduces diagnostic specificity.
Example
Documentation: “Oropharyngeal dysphagia following cerebral infarction.”
The coder should investigate the applicable I69.- sequela code and any additional coding instructions rather than automatically reporting R13.10.
5. Coding a fluoroscopic finding as a new diagnosis
An MBS may reveal aspiration, penetration, residue, delayed swallow initiation, reduced airway protection, or other physiologic findings.
Those findings do not automatically authorize the coder to assign an unrelated disease diagnosis.
The coder should follow the applicable documentation and coding guidelines and query the provider when clarification is necessary.
6. Confusing an MBS with FEES
MBS/VFSS uses fluoroscopic imaging and barium-containing materials. FEES uses endoscopic visualization.
For the SLP, 92611 is associated with the MBS/VFSS service, while 92612 represents FEES.
Modified Barium Swallow Coding Examples
| Clinical documentation | Suggested coding approach | Main coding point |
| “Difficulty swallowing; no further specificity” | Consider R13.10 when supported | Do not invent a swallowing phase |
| “Oral phase dysphagia” | R13.11 | Use documented phase specificity |
| “Oropharyngeal dysphagia” | R13.12 | More specific than R13.10 |
| “Pharyngeal phase dysphagia” | R13.13 | Use when provider documentation supports it |
| “Pharyngoesophageal dysphagia” | R13.14 | Specific phase/category |
| “Other specified dysphagia” | R13.19 | Use when documentation fits the category |
| “Dysphagia following cerebral infarction” | Review applicable I69.391 coding | Etiology/sequela relationship matters |
| “Dysphagia following nontraumatic SAH” | Review I69.091 | Do not default to an R13 symptom code when a specific sequela relationship is documented |
| “MBS/VFSS performed by SLP” | Evaluate 92611 | Procedure code reflects the SLP’s instrumental service |
| “Radiologic swallowing examination” | Evaluate 74230 | Radiology service is distinct from the SLP service |
| “Clinical swallowing evaluation only” | Evaluate 92610 | Do not substitute MBS code without an MBS |
| “FEES performed” | Evaluate 92612 | FEES is not an MBS |
These are coding examples, not automatic claim instructions. The actual record, provider role, place of service, payer policy, and date-specific coding rules control the final claim.
Can Dysphagia Be Coded From MBS Findings Alone?
Generally, coders should distinguish clinical evidence from provider documentation.
An MBS report can contain highly detailed physiologic observations. However, a coder should not independently turn every observation into a diagnosis simply because it appears in the test report.
For example, a report may describe:
- Reduced tongue-base retraction
- Delayed swallow initiation
- Vallecular residue
- Penetration
- Aspiration
- Reduced laryngeal elevation
- Pharyngeal residue
These findings may be clinically important, but the coding question is whether the documentation establishes a reportable diagnosis under the applicable coding rules.
If the medical record contains conflicting information, insufficient specificity, or an unclear relationship between dysphagia and an underlying disease, a compliant provider query may be appropriate.
The query should seek clarification rather than lead the provider toward a desired diagnosis.
Outpatient vs. Inpatient MBS Diagnosis Coding
The distinction between outpatient and inpatient diagnosis coding is important when documentation contains uncertain diagnoses.
Outpatient encounters
For outpatient coding, diagnoses documented as probable, suspected, questionable, rule-out, or similar uncertain conditions generally are not coded as confirmed diagnoses simply because the clinician is evaluating for them.
Instead, the signs, symptoms, confirmed conditions, or other diagnoses supported by the documentation are coded according to the applicable outpatient rules.
For an outpatient MBS, therefore, a suspected diagnosis should not automatically become the final ICD-10-CM diagnosis.
Inpatient admissions
Inpatient hospital coding follows different rules for certain uncertain diagnoses documented at discharge.
Because the MBS itself does not determine whether the encounter is subject to inpatient or outpatient coding rules, the coding team must first establish the encounter type and then apply the correct Official Guidelines.
The FY 2026 ICD-10-CM Official Guidelines are published by CMS and NCHS and apply for the specified fiscal-year period.
Common Modified Barium Swallow Coding and Billing Mistakes
Using 92610 for every swallowing evaluation
Why it happens: Staff may use a general swallowing-evaluation code as a default.
Correct approach: Determine whether the patient received a clinical swallowing evaluation or an instrumental MBS/VFSS. For the SLP component of an MBS, evaluate CPT 92611.
Billing both 92611 and 74230 without reviewing payer/edit rules
Why it happens: Both services are associated with the same MBS encounter.
Correct approach: Identify the provider responsible for each component and check the applicable NCCI and payer rules. CMS updates NCCI files quarterly.
Using R13.10 when a more specific diagnosis is documented
Why it happens: R13.10 is easy to recognize and appears frequently in dysphagia claims.
Correct approach: Use the highest level of specificity supported by the documentation.
Assuming aspiration automatically determines the diagnosis
Why it happens: Aspiration is a clinically significant MBS finding.
Correct approach: Do not independently establish a disease or causal diagnosis from a test finding. Review provider documentation and query when clarification is needed.
Missing a cerebrovascular sequela code
Why it happens: The coder focuses on the swallowing symptom and overlooks the documented stroke relationship.
Correct approach: Search the ICD-10-CM Index and Tabular List for the documented relationship. The FY 2026 Index includes specific dysphagia-after-cerebrovascular-event codes.
Using outdated code-set information
Why it happens: Billing references, EHR favorites, or claim-scrubbing rules are not updated on schedule.
Correct approach: Validate the code against the applicable date of service and current official code set.
Assuming a correct CPT guarantees reimbursement
Why it happens: Procedure-code selection is treated as the entire billing process.
Correct approach: Separately evaluate coverage, medical necessity, authorization, provider eligibility, place of service, diagnosis support, NCCI edits, and payer-specific requirements.
Best Practices for Clean Modified Barium Swallow Claims
Build diagnosis-specific documentation prompts
EHR templates can prompt clinicians to document:
- Reason for instrumental assessment
- Dysphagia type when clinically established
- Relevant underlying condition
- Relationship between dysphagia and underlying disease when known
- Prior clinical findings
- MBS/VFSS indication
- SLP service provided
- Recommendations resulting from the study
Templates should support documentation rather than force a diagnosis.
Create targeted claim edits
A billing system can flag claims when:
- 92611 is reported without an appropriate swallowing-related diagnosis
- An unspecified dysphagia code is repeatedly used despite more specific documentation
- 92610 and 92611 appear together without documentation supporting distinct services
- 92611 and 74230 are reported by the same billing entity
- A diagnosis code is invalid for the date of service
- An applicable NCCI edit is present
These edits should be reviewed against current payer rules rather than hard-coded permanently.
Review payer policy before the service
Medicare rules provide an important baseline, but commercial plans and Medicaid programs may impose additional requirements.
For Medicare, use the applicable CMS resources, including the current Physician Fee Schedule and NCCI files. CMS’s NCCI program notes that its edits do not determine coverage or medical necessity, so those questions must be reviewed separately.
Monitor unspecified-code utilization
A high percentage of MBS claims using R13.10 may indicate:
- Clinicians are documenting insufficient specificity.
- Coders are not capturing available specificity.
- The EHR diagnosis list is poorly configured.
- Coding staff are relying on historical defaults.
A periodic chart audit can identify which problem is occurring.
Query instead of assuming
When documentation supports more than one plausible coding interpretation, a compliant query can be safer than guessing.
For example, if the record documents dysphagia and a history of stroke but never states whether the dysphagia is a sequela of the stroke, the coder should not independently create that causal relationship.
Modified Barium Swallow Claim Verification Checklist
Before submitting an MBS claim, review the following:
| Verification item | Claim review question |
| Provider documentation | Is the swallowing problem or diagnosis documented? |
| Procedure performed | Was an MBS/VFSS actually performed? |
| CPT selection | Does 92611 accurately represent the SLP service provided? |
| Radiology service | If applicable, is 74230 being reported by the appropriate provider/entity? |
| Diagnosis specificity | Is the most specific supported ICD-10-CM diagnosis selected? |
| Underlying condition | Is an etiologic or sequela condition documented? |
| Sequencing | Were applicable ICD-10-CM instructions followed? |
| Date validity | Are CPT and ICD-10-CM codes valid for the date of service? |
| NCCI | Were current Medicare or applicable payer edits reviewed? |
| Medical necessity | Does the diagnosis and documentation support the study? |
| Authorization | Did the payer require prior authorization or notification? |
| Provider eligibility | Is the reporting provider permitted to bill the service under the payer’s rules? |
| Claim duplication | Is the same service being unintentionally reported twice? |
| Supporting report | Is the MBS/VFSS report available if requested? |
Frequently Asked Questions
What is the Modified Barium Swallow CPT code?
The primary Modified Barium Swallow CPT code for the SLP component is 92611. The radiologic component is associated with CPT 74230. The two codes represent different portions of the MBS/VFSS service and should not be treated as interchangeable.
What ICD-10 code is used for a modified barium swallow?
There is no single ICD-10-CM diagnosis code specifically for an MBS procedure. The diagnosis code explains the patient’s clinical reason for the study. Common dysphagia codes include R13.10, R13.11, R13.12, R13.13, R13.14, and R13.19, depending on provider documentation.
What is the ICD-10 code for oropharyngeal dysphagia?
The ICD-10-CM code for oropharyngeal dysphagia is R13.12. It should be used when the documentation specifically supports oropharyngeal dysphagia rather than simply “difficulty swallowing” or unspecified dysphagia.
What is the difference between CPT 92610 and 92611?
92610 is used for the clinical evaluation of oral/pharyngeal swallowing function, while 92611 represents the SLP’s instrumental videofluoroscopic swallowing evaluation. An MBS/VFSS should not automatically be reported with 92610 simply because a swallowing evaluation occurred.
Can CPT 92611 and 74230 be billed together?
They may represent different professional components of the same MBS/VFSS, but billing them together requires review of the providers involved, payer rules, and applicable NCCI edits. CMS maintains current NCCI files, and ASHA identifies 92611 as the SLP component and 74230 as the radiology component.
Can aspiration on an MBS report be coded automatically as a diagnosis?
No. A coder should not independently establish a disease diagnosis solely from an MBS finding. The record must support the diagnosis under applicable coding rules. If documentation is unclear, a compliant provider query may be appropriate.
When should R13.10 be used?
R13.10 is appropriate when dysphagia is documented but the record does not support a more specific dysphagia type or phase. It should not be used merely as a convenient default when the provider has documented greater specificity.
What code applies when dysphagia follows a stroke?
The appropriate code depends on the type of cerebrovascular event and documentation. For example, I69.391 identifies dysphagia following cerebral infarction. Other I69 codes apply to dysphagia following specified hemorrhagic or other cerebrovascular conditions.
Is 92611 the same as FEES?
No. 92611 is associated with the SLP’s MBS/VFSS service, while 92612 is used for flexible endoscopic evaluation of swallowing with cine/video recording. These are different instrumental swallowing procedures.
Does the correct Modified Barium Swallow CPT code guarantee payment?
No. Correct CPT selection is only one part of successful reimbursement. Coverage, medical necessity, diagnosis support, authorization, provider eligibility, NCCI edits, place of service, documentation, and payer-specific requirements can all affect payment. CMS also distinguishes NCCI correct-coding edits from medical-necessity determinations.
How often should billing teams review NCCI rules for MBS claims?
Medicare NCCI PTP and MUE files are updated at least quarterly. Billing teams should therefore use the version applicable to the claim’s date of service rather than relying on an old edit table.
Conclusion
Accurate Modified Barium Swallow CPT code selection depends on the service performed, the provider involved, and complete clinical documentation. For the SLP component, CPT 92611 is typically the key code to review, while CPT 74230 represents the associated radiologic examination.
Using the correct CPT and ICD-10-CM codes, verifying medical necessity, and following payer and NCCI requirements can help prevent avoidable denials and billing delays. Philadelphia Medical Billing, a medical billing company serving healthcare providers in Philadelphia, helps practices manage coding and billing workflows with greater accuracy and efficiency.