Key facts for NCD 170.3
- Benefit category
- Outpatient Speech Language Pathology Services
- Effective date
- 10/01/2006
- Implemented 10/02/2006
- Transmittal
- Transmittal 55
- Versions published
- 2
- Manual chapter
- 170
- NCD Manual (Pub. 100-03)
TL;DR
NCD 170.3 sets Medicare's national policy for speech-language pathology services for the treatment of dysphagia under the benefit category "Outpatient Speech Language Pathology Services", effective 10/01/2006 and implemented 10/02/2006. Speech-language pathology services are covered under Medicare for the treatment of dysphagia, regardless of the presence of a communication disability. It has been revised 1 time since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
Dysphagia is a swallowing disorder that may be due to various neurological, structural, and cognitive deficits. Dysphagia may be the result of head trauma, cerebrovascular accident, neuromuscular degenerative diseases, head and neck cancer, and encephalopathies. While dysphagia can afflict any age group, it most often appears among the elderly.
Patients who are motivated, moderately alert, and have some degree of deglutition and swallowing functions are appropriate candidates for dysphagia therapy. Elements of the therapy program can include thermal stimulation to heighten the sensitivity of the swallowing reflex, exercises to improve oral-motor control, training in laryngeal adduction and compensatory swallowing techniques, and positioning and dietary modifications. Design all programs to ensure swallowing safety of the patient during oral feedings and maintain adequate nutrition.
Indications and limitations of coverage
Speech-language pathology services are covered under Medicare for the treatment of dysphagia, regardless of the presence of a communication disability.
Text reproduced from the CMS Medicare Coverage Database record for NCD 170.3 version 2. View the original on cms.gov.
Revision history
05/2006 - Issued. Effective date: 10/01/2006. ( TN 55 ) CR4014
08/1989 - Covered regardless of presence of a communication disability. Effective date 08/28/1989. (TN 39)
How this NCD shows up on remittances
A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.
How QuickIntell applies NCD 170.3
QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.
Frequently asked questions — NCD 170.3
What does NCD 170.3 cover?
Speech-language pathology services are covered under Medicare for the treatment of dysphagia, regardless of the presence of a communication disability. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 170.3 take effect?
The current version (2) is effective 10/01/2006, implemented 10/02/2006, published in transmittal 55. CMS lists 2 versions of this NCD.
Does a Local Coverage Determination override NCD 170.3?
No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database NCDs via the CMS Coverage APIVersion API snapshot 2026-09-27 · effective 2026-09-20 · file national-coverage-ncd.jsonSHA-256 a90fadfd264b9ef4…
Disclaimer
This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.