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Why choose FEES over MBSS? 


Exposure risks.

  • FEES does not use barium and involves no radiation exposure. Food/drink is dyed using FDA approved green food coloring. This allows for its distinction against laryngeal and pharyngeal structures.

  • MBSS is completed under video fluoroscopy (moving X-ray), which involves radiation exposure. To limit patient exposure, the x-ray image is turned on for short periods of time and the duration of the exam is limited to only a few minutes. This time constraint can sometimes limit clinical findings (e.g., fatigue factors, increased respiratory/swallow discoordination, reflux findings, etc.).


Positioning limitations.

  • FEES is an endoscopic exam that is portable and thus can be performed at the patient’s bedside. FEES is completed in any position the patient will be in during eating. 

  • MBSS is completed in a radiology suite, thus, patients must be transported to the hospital. Patients are seated upright to clearly view swallowing structures. This process is less conducive for specific populations (e.g., bariatric, ventilator-dependent, easily fatigued, painful wounds, etc.). 


Poor respiratory status with concern of aspiration during exam.

  • Aspiration of secretions is the biggest predictor for aspiration pneumonia (7).

  • FEES can examine secretion (saliva) management and can detect aspiration of a patient’s own secretions. FEES is a sensitive and conservative exam. Aspiration of secretions and ice chips can be evaluated to gain critical information on a patient’s anatomic and physiologic swallow impairments. Even conservative exams can yield appropriate therapy plans! No need to delay testing for patients who have severe-profound dysphagia.

  • MBSS does not detect secretions, thus cannot detect aspiration of secretions before testing foods/liquids.



  • Due to its portability, FEES can be conducted in any setting. Patients do not need to be transported to an outside facility, and with SCOPE Speech-Language Pathology, the FEES can be completed within 1-3 business days. This means no delays in scheduling due to coordination with busy radiology departments. 

  • MBSS is scheduled with the radiology department. This can sometimes result in delayed access to this essential exam, which in turn can result in misdiagnosis and higher risk for re-hospitalization due to dysphagia-related complications.


Pictures are priceless. 

  • FEES completed by SCOPE Speech-Language Pathology will provide you with a report the same day. The report will also include pictures of significant findings.

  • MBSS reports must be requested through a facility’s medical records department. This can results in delayed access to detailed results.



  • FEES is performed in your facility. No extra cost for transportation.  

  • MBSS is performed in outpatient setting. Therefore, the facility must pay for transportation to and from the exam.

  • FEES is performed by a Speech Language-Pathologist (SLP). The exam does not require presence of a Doctor.

  • MBSS is performed by a SLP, Radiologist, and Radiology Technician. The cost to complete this exam includes the cost of all three team members.

  • FEES with SCOPE Speech-Language Pathology is billed as a one-time flat charge, with no hidden costs. Ask us about our billing process and how your facility can be reimbursed and spend significantly less overall.

  • With FEES, the facility does not miss out on designated treatment minutes. The facility’s SLP is able to bill their therapy treatment code while assisting with the exam. This means that completing the FEES will not disrupt productivity for skilled residents or result in denial of facility SLP claims for managed care residents.

  • With MBSS, the procedure takes only a few minutes, however the patient is gone from the facility for multiple hours. While the patient is gone, the patient and facility misses out on designated therapy minutes for the day, affecting productivity, and ultimately affecting the RUG level. 

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