Patient self-assessment measures such as Voice Handicap Index (VHI), VHI-10, Voice-Related Quality of Life (V-RQOL) or other validated patient-reported outcome measures, recorded pre- and post-therapy
Acoustic and aerodynamic objective measures where appropriate (e.g., jitter, shimmer, noise-to-harmonics ratio, Dysphonia Severity Index [DSI], Acoustic Voice Quality Index [AVQI], maximum phonation time [MPT], phonation quotient, relative fundamental frequency [RFF])
Documented trial of conservative management where appropriate (e.g., voice rest, vocal hygiene, indirect therapy) and results of that trial prior to or alongside proceeding to more invasive therapy or surgery
Key Coverage Criteria
Essential voice tremor
Paradoxical vocal fold motion (vocal cord dysfunction) — voice therapy focusing on vocal cord relaxation techniques and breathing exercises
Mutational falsetto and other functional voice disorders — voice therapy (direct and indirect techniques)
ICD-10 covered diagnoses referenced in the policy: J38.00 - J38.02 (Paralysis of vocal cords and larynx)
ICD-10 covered diagnoses referenced in the policy: J38.1 (Polyp of vocal cord and larynx)
ICD-10 covered diagnoses referenced in the policy: J38.2 (Nodules of vocal cords)
For paradoxical vocal fold motion, pulmonary function testing and flow-volume loop documentation (inspiratory loop flattening) to help discriminate from asthma, plus direct visualization findings
Documentation of multidisciplinary evaluation and co-management as indicated (e.g., laryngologist and SLP collaboration for MTD, BVFLs, pre-/post-op care)