Policy Definition
Audiology is the study of hearing and hearing disorders and includes habilitation and rehabilitation for individuals who have hearing loss
Provider Billing Guidelines and Documentation Coding
Code Description Comments
92550–92588 Audiometric tests Bill once with a count of one
92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
92601–92604 Diagnostic analysis of cochlear implant; with programming; subsequent reprogramming
92605 Evaluation for prescription of non speech generating augmentative and alternative communication device Reimbursed for facility only
92606 Therapeutic service(s) for the use of non speech generating device, including programming and modification
92607–92609 Speech generating and non-speech generating augmentativeand alternative communication device-related services
To bill professional component of service use CPT; to bill DME component, refer to Durable Medical Equipment (DME).
92620, 92621 Evaluation of central auditory function, with report
92625 Assessment of tinnitus
92626 Evaluation of auditory rehabilitation status; first hour
92627 Evaluation of auditory rehab status; ea add’l 15 minutes Bill in conjunction with 92626
92630 Auditory rehabilitation; pre-lingual hearing loss
92633 Auditory rehabilitation; post-lingual hearing loss
92700 Unlisted otorhinolaryngological service or procedure Submit documentation of services rendered
Modifiers
• When billing for monaural hearing aids, a RT or LT modifier in the second modifier field is required for payment. Claims submitted without the RT or LT modifier may be denied.
• When billing for a binaural hearing aid the RT or LT modifier is not required. Claims submitted with a RT or LT modifier will be denied as inappropriately billed.
AUDIOLOGY SERVICES Payable Codes to Audiologists
SERVICE DESCRIPTION CODE
Spontaneous Nystagmus; w/record 92541
Positional Nystagmus; w/record 92542
Caloric Vestibular Test; w/record 92543
Optokinetic Nystagmus; w/record 92544
Oscillating Tracking; w/record 92545
Use of Vertical Electrodes 92547
Screening Test, Pure Tone, Air Only 92551
Pure Tone Audiometry; Air Only 92552
Pure Tone Audiometry; Air and Bone 92553
Speech Audiometry Threshold 92555
Speech Audiometry Threshold; with speech recognition 92556
Comprehensive Audiometry 92557
Tone Decay Test 92563
Short Increment Sensitivity Index 92564
Stenger Test, Pure Tone 92565
Tympanometry 92567
Acoustic Reflex Testing; Threshold 92568
Acoustic Reflex Testing; Decay 92569
Filtered Speech Test 92571
Staggered Spondaic Word Test 92572
Sensorineural Acuity Level Test 92575
Synthetic Sentence ID Test 92576
Stenger Test, Speech 92577
Visual Reinforcement Audiometry (VRA) 92579
Conditioning Play Audiometry 92582
Select Picture Audiometry 92583
Electrocochleography 92584
Auditory Evoked Potentials; Comprehensive 92585
Auditory Evoked Potentials; Limited 92586
Evoked Otoacoustic Emissions; Limited 92587
Evoked Otoacoustic Emissions; Comprehensive 92588
Hearing Aid Exam/Selection; Monaural 92590
Hearing Aid Exam/Selection; Binaural 92591
Hearing Aid Check; Monaural 92592
Hearing Aid Check; Binaural 92593
Electroacoustic Evaluation Hearing Aid; Monaural 92594
Electroacoustic Evaluation Hearing Aid; Binaural 92595
Evaluation of Central Auditory Function w/report; init 60 Min 92620
Evaluation of Central Auditory Function; ea additional 15 Min 92621
Assessment of Tinnitus Assessment 92625
Restrictions
• Payment for the following codes is restricted to one each per recipient per 180 days
92552 92553 92555 92556 92557 92563 92564 92565 92567 92568 92569 92571 92572 92575 92576 92577 92579 92582 92583 92584 92585
• Audiologist are reminded that for recipients in the CommunityCARE program, there must be a written authorization from the recipient’s PCP for the audiologist’s services. This includes recipients that are referred to them by the Head Start program.
Audiologists Employed by Hospitals
Audiologists who are salaried employees of hospitals cannot bill Medicaid for their professional services rendered at that hospital because their services are included in the hospital’s per diem rate. Audiologists can enroll and bill Medicaid if they are providing services at a hospital at which there is no audiologist on staff.
B. Billing for Audiology Services
See the CMS Web site at http://www.cms.gov/PhysicianFeeSched/50_Audiology.asp for a listing of all CPT codes for audiology services. For information concerning codes that are not on the list, and which codes may be billed when furnished by technicians, contractors shall provide guidance. The Physician Fee Schedule at
http://www.cms.gov/PFSlookup/01_Overview.asp#TopOfPage allows you to search pricing amounts, various payment policy indicators, RVUs, and GPCIs.
Audiology services may not be billed when the place of service is a comprehensive outpatient rehabilitation facility (CORF) or a rehabilitation agency.
Audiology services may be furnished and billed by audiologists and, when these services are furnished by an audiologist, no physician supervision is required.
The interpretation and report shall be written in the medical record by the audiologist, physician, or NPP who personally furnished any audiology service, or by the physician who supervised the service. Technicians shall not interpret audiology services, but may record objective test results of those services they may furnish under direct physician supervision. Payment for the interpretation and report of the services is included in payment for all audiology services, and specifically in the professional component if the audiology service has a professional component/technical component split.
1. Billing under the MPFS for Audiology Services Outside the Facility Setting
The individuals who furnish audiology services in all settings must be qualified to furnish those services. The qualifications of the individual performing the services must be consistent with the number, type and complexity of the tests, the abilities of the individual, and the patient’s ability to interact to produce valid and reliable results. The physician who supervises and bills for the service is responsible for assuring the qualifications of the technician, if applicable are appropriate to the test.
a.Professional Skills.
When a professional personally furnishes an audiology service, that individual must interact with the patient to provide professional skills and be directly involved in decision-making and clinical judgment during the test.
The skills required when professionals furnish audiology services for payment under the MPFS are masters or doctoral level skills that involve clinical judgment or assessment and specialized knowledge and ability including, but not limited to, knowledge of anatomy and physiology, neurology, psychology, physics, psychometrics, and interpersonal communication. The interactions of these knowledge bases are required to attain the clinical expertise for audiology tests. Also required are skills to administer valid and reliable tests safely, especially when they involve stimulating the auditory nerve and testing complex brain functions.
Diagnostic audiology services also require skills and judgment to administer and modify tests, to make informed interpretations about the causes and implications of the test results in the context of the history and presenting complaints, and to provide both objective results and professional knowledge to the patient and to the ordering physician.
Examples include, but are not limited to:
*Comparison or consideration of the anatomical or physiological implications of test results or patient responsiveness to stimuli during the test;
*Development and modification of the test battery and test protocols;
*Clinical judgment, assessment, evaluation, and decision-making;
*Interpretation and reporting observations, in addition to the objective data, that may influence interpretation of the test outcomes;
*Tests related to implantation of auditory prosthetic devices, central auditory processing, contralateral masking; and/or
*Tests to identify central auditory processing disorders, tinnitus, or nonorganic hearing loss.
Audiology codes may be billed under the MPFS by audiologists, physicians, and NPPs using their own NPI in the rendering loop when those professionals personally furnish the test. Physicians and NPPs may not bill for these codes when an audiologist has furnished the service.
b.Technician Skills.
There may be subtests, or parts of a battery of tests, that may be appropriately furnished by an educated and experienced technician using a specific protocol under the direction of a supervising physician. These services are identified by local contractor determination as services that do not require professional skills. They may be furnished by a qualified technician under the direct supervision of a physician, but not under the supervision of an audiologist or an NPP. The supervising physician is responsible for rendering and documenting all clinical judgment and for the appropriate provision of the service by the technician.
A technician may not perform any part of a service that requires professional skills. A technician also may not perform a global service. For example, a technician may not interpret test results or engage in clinical decision-making.
c.Professional Component (PC)/Technical Component (TC) Split Codes.
*The PC of a PC/TC split code may be billed by the audiologist, physician, or NPP who personally furnishes the service. (Note this is also true in the facility setting.) A physician or NPP may bill for the PC when the physician or NPP furnish the PC and an (unsupervised) audiologist furnishes and bills for the TC. The PC may not be billed if a technician furnishes the service. A physician or NPP may not bill for a PC service furnished by an audiologist.
*The TC of a PC/TC split code may be billed by the audiologist, physician, or NPP who personally furnishes the service. Physicians may bill the TC for services furnished by technicians when the technician furnishes the service under the direct supervision of that physician. Audiologists and NPPs may not bill for the TC of the service when a technician furnishes the service, even if the technician is supervised by the NPP or audiologist.
*The “global” service is billed when both the PC and TC of a service are personally furnished by the same audiologist, physician, or NPP. The global service may also be billed by a physician, but not an audiologist or NPP, when a technician furnishes the TC of the service under direct physician supervision and that physician furnishes the PC, including the interpretation and report.
d.Tests that are Not Described by Specific CPT Codes. Tests that have no appropriate CPT code may be reported under CPT code 92700 (Unlisted otorhinolaryngological service or procedure).
e.Tests that are Contractor-Priced. For codes valued by contractors, the contractor determines whether and how much, if applicable, to pay for the service. The contractor sets the requirements for personnel furnishing the tests.
2.Billing for Audiology Services Furnished to Hospital Outpatients.
All codes may be reported for audiology services furnished in the hospital outpatient setting and, in such cases, the code represents the facility service for the diagnostic test. All audiology services furnished to hospital outpatients must be billed and paid to the hospital under the OPPS or other applicable hospital payment system. The hospital bills its fiscal intermediary or Medicare administrative contractor (A/B MAC) and is paid for the facility resources required to furnish the services, regardless of whether the service is furnished by a physician, NPP, audiologist, or technician.
Physicians, NPPs, and audiologists cannot bill and be paid for the TC of PC/TC split codes when these services are furnished to hospital outpatients. The associated professional services (represented by the PC or the CPT code for the audiology test which has no PC/TC split) of an enrolled audiologist, physician, or NPP who has reassigned benefits may be billed by the hospital to the carrier or A/B MAC, as appropriate.
Alternatively, if the physician, NPP, or audiologist has not assigned benefits, the professional would bill his/her carrier or A/B MAC for the professional services furnished.
The appropriate revenue code for reporting audiology services is 0470 (Audiology; General Classification). Providers are required to report a line-item date of service per revenue code line for audiology services.
3.Billing for Audiology Services Furnished to Skilled Nursing Facility (SNF) Patients.
Payment for the facility resources (including the TC of PC/TC split codes) of audiology services provided to Part A inpatients of SNFs is included in the PPS rate. For SNFs, if the beneficiary has Part B but not Part A coverage (e.g., Part A benefits are exhausted), the SNF may elect to bill for audiology services but is not required to do so. As explained in Pub. 100-04, chapter 7, section 40.1, since audiology services furnished during a noncovered SNF stay are not bundled with speech-language pathology services, payment can be made either to the SNF or to the audiology service provider/supplier.
Audiologists, physicians, and NPPs enrolled in Medicare may bill directly for services rendered to Medicare beneficiaries who are in a SNF stay that is not covered by Part A but who have Part B eligibility. Payment is made based on the MPFS, whether on an institutional or professional claim. For beneficiaries in a noncovered SNF stay, audiology services are payable under Part B when billed by the SNF on an institutional claim as type of bill 22X, or when billed directly by the provider or supplier of the service (the audiologist, physician, or NPP who personally furnishes the test) on a professional claim. For PC/TC split codes, the SNF may elect to bill for the TC of the test on an institutional claim but is not required to bill for the service.
C – Implant Processing
Payment for diagnostic testing of implants, such as cochlear, osseointegrated or brainstem implants, including programming or reprogramming following implantation surgery is not included in the global fee for the surgery.
The diagnostic analysis of a cochlear implant shall be billed using CPT codes 92601 through 92604.
Osseointegrated prosthetic devices should be billed and paid for under provisions of the applicable payment system. For example, payment may differ depending upon whether the device is furnished on an inpatient or outpatient basis, and by a hospital subject to the OPPS, or by a Critical Access Hospital, physician’s clinic, or a Federally Qualified Health Center.
D – Aural Rehabilitation Services
General policy for evaluation and treatment of conditions related to the auditory system.
For evaluation of auditory processing disorders and speech-reading or lip-reading by a speech-language pathologist, use the untimed code 92506 with “1” as the unit of service, regardless of the duration of the service on a given day. This “always therapy” evaluation code must be provided by speech-language pathologists according to the policies in Pub. 100-02, chapter 15, sections 220 and 230. The codes 92620 and 92621 are diagnostic audiological tests and may not be used for SLP services.
For treatment of auditory processing disorders or auditory rehabilitation/auditory training (including speech-reading or lip-reading), 92507, and 92508 are used to report a single encounter with “1” as the unit of service, regardless of the duration of the service on a given day. These codes always represent SLP services. See Pub. 100-02, chapter 15, sections 220 and 230 for SLP policies. These SLP evaluation and treatment services are not covered when performed or billed by audiologists, even if they are supervised by physicians or qualified NPPs.
For evaluation of auditory rehabilitation to instruct the use of residual hearing provided by an implant or hearing aid related to hearing loss, the timed codes 92626 and 92627 are used. These are not “always therapy” codes. Evaluation of auditory rehabilitation shall be appropriately provided and billed by an audiologist or speech-language pathologist.
Also, these services may be provided incident to a physician’s or qualified NPP’s service by a speech-language pathologist, or personally by a physician or qualified NPP within their scope of practice. Evaluation of auditory rehabilitation is a covered diagnostic test when performed and billed by an audiologist and is an SLP evaluation service covered under the SLP benefit when performed by a speech-language pathologist.