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How to Order an MBS or FEES in a SNF

6/4/2026

There will be times when you need to order an MBS or a FEES. Hopefully, when you have a patient under Medicare Part A, they completed a study in the hospital. However, there may be a point in your treatment plan where you need a repeat instrumental. Or if you have long term care patients, you will definitely want to order an MBSS or FEES to objectively assess their swallowing physiology to develop an effective plan of care.

  1. Your building needs to have a contract with a local MBS or FEES company (or both!). Ask your Director of Rehab if your building already has a contract with a company. If they are not sure, then you need to ask the building administrator. If your building does not have a current contract, you will have to find a company that offers these services and the administrator will have to be the one to sign a contract with them.

  2. Go to the website for the local MBS or FEES company and follow the directions on their website for how to submit a referral. Typically, a consent form, face sheet, medication list, and history & physical is required documentation to include in the referral.

  • Discuss the recommendation and obtain consent from the patient and/or their legal representative.
  • Fill out the referral form with all the patient information yourself, so that all the MD has to do is sign it. Bring the completed form directly to the MD or ask the DON to get it signed for you.
  • Fax and/or email the signed order and required information. The company should reach out to you for scheduling.

My administrator says I’m not allowed to order swallow studies. What do I do now?

  1. The most important thing is to document that you recommend an MBS/FEES be completed and that the DOR/DON/etc. was informed. Continue to document this throughout your plan of care. The building is required to follow SLP recommendations in order to stay in compliance, but if you don’t write it down, there is no evidence that you recommended it & it was not provided. Documentation examples:
  • “Awaiting approval for swallow imaging”
  • “Awaiting requested imaging”
  • “Recommendation for swallow imaging reiterated to DOR and DON”

  1. Discuss your recommendation for a swallow study with the patient as well as with the legal guardian. With the patient and/or legal representative aware of the recommendation and also asking the building administration when the study will be completed, this can create additional pressure to help get the study completed.

  2. It is not appropriate, but I have heard a lot of stories about administrations declining to provide swallow studies because they do not want to pay for it. A lot of people just assume how much a study costs. If you call the MBS or FEES company your building has a contract with and provide them with the name of your building and the patient’s insurance, they will be able to provide you with the exact cost. This way, you are at least advocating with factual numbers, not an assumed $900.

  3. When you are advocating, compare a swallow study to a hip x-ray. If a patient fell and was having pain, an x-ray would immediately be ordered to assess for a fracture. Very similarly, if a patient is having symptoms of dysphagia, an MBS/FEES needs to be ordered to confirm the dysphagia and determine the physiology in order to develop an appropriate treatment plan. A physical therapist would not start treating someone whose injury is undiagnosed.