What is FEES?

Fiberoptic Endoscopic Evaluation of Swallowing - FEES

Fiberoptic Endoscopic Evaluation of Swallowing is an instrumental examination utilized by a qualified and licensed Speech Language Pathologist (SLP) for patients with dysphagia (a swallowing disorder).  FEES involves passing a scope along the floor of the nasal cavity to the back of the throat in order to directly assess the pharynx, larynx and upper esophageal opening.  During the exam, the patient is given various items to eat and drink, dyed green to evaluate swallow function, safest diet level and level of aspiration.

FEES may also be beneficial in determining treatment strategy effectiveness and providing therapeutic biofeedback to maximize a patients performance.  The FEES procedure is an evidenced-based, cost-effective alternative to Modified Barium Swallow Studies (MBS). There are many advantages to FEES when compared to an MBS including: significant cost savings, exceptional accuracy and reliability with findings, which are imperative for an effective plan of treatment to promote optimal and recovery of the swallow function.      



FEES Procedure:

We will respond to your request within 24-48 hours to coordinate a time to perform a FEES procedure on your patient.   ​The entire procedure takes about 20-30 minutes to complete.

You will receive a detailed report with results and recommendations for your patient to implement immediately in your treatment plan.   You don't have to wait for a report to be sent to you!  Before we leave your facility, we provide a written report with picture representation to support results and recommendations.  Informed consent is available to provide your facility if required.

Candidates for FEES:

FEES can be performed on any patient excluding those with evidence of bilateral nasal obstruction; facial, maxillary or nasal fractures; or severe epistaxis (nose bleeds).   

Billing procedure for FEES: 

We follow CMS guidelines of Consolidated Billing established from the Balanced Budget Act of 1997.  The consolidated billing requirement "confers on the SNF the billing responsibility for the entire package of care that residents receive during a covered Part A SNF stay and physical, occupational, and speech therapy services received during a non-covered stay." FEES is considered a "speech therapy service" and is billed under the consolidated billing guidelines.    


Risks and level of comfort associated with FEES:

Research reveals risks associated with endoscopy are mild and EXTREMELY rare (less than 1%) with minimal discomfort.

FEES History:

Fiberoptic Endoscopic Ealuation of Swallowing (FEES) was created by  Dr. Susan Langmore in 1988.  Since that time it has been found to be an cost effective, evidenced-based and safe procedure to assess dietary and behavioral management strategies with patients exhibiting swallowing deficits.    

FEES has revolutionized the field of dysphagia diagnostics and management as practical and valuable alternative to an Modified Barium Swallow Study (MBS)  to decrease risk of aspiration pneumonia.  Across the nation, FEES is now being utilized more often than an MBS due to the lower cost, portability, convenience and reliability of findings.  For additional information on the evolution of FEES, see History of Fiberoptic Endoscopic Evaluation of Swallowing for Evaluation and Management of Pharyngeal Dysphagia: Changes over the Years.  Dr. Susan E. Langmore.  Dysphagia (2017) 32:27-38

Dr. Susan Langmore performing FEES
Dr. Susan Langmore performing FEES