In January 2020, the American Academy of Audiology (the Academy) published its Clinical Guidance Document on the Assessment of Hearing in Infants and Young Children. The document covers four content areas: Pediatric Audiometry, Acoustic Immittance, Otoacoustic Emissions, and Electrophysiologic Audiometry. This article provides guidance on filing claims for pediatric audiometry and electrophysiologic audiometry. Coding for otoacoustic emissions and acoustic immittance are discussed elsewhere (Academy, Pediatric Audiology Billing & Coding Questions & Answers).

Coverage policies for pediatric assessment will vary from payer to payer. Benefits provided through Medicaid or Children’s Health Insurance Program (CHIP) plans will vary from state to state. Clinicians are encouraged to contact insurers and reference coverage policies regarding payer-specific coding guidance. The purpose of this article is to discuss considerations when filing claims for pediatric assessment procedures.

Pediatric Audiometry

Behavioral Audiometry

Behavioral audiometric evaluation methods will vary given the patient age. Behavioral observation audiometry (BOA), visual reinforcement audiometry (VRA), and conditioned play audiometry (CPA) are standard clinical procedures used to assess hearing in infants, children, and difficult-to-test patients. 

BOA does not currently have a unique code for billing applications. This section will discuss considerations when billing for VRA and CPA procedures using the following current procedural terminology codes (CPT©, American Medical Association).

92579 Visual Reinforcement Audiometry is used to estimate hearing sensitivity by determining the type and severity of hearing loss using a reinforced response procedure. Code descriptions of 92579 reflect standard clinical assessment practices, necessitate the use of calibrated equipment, and include recording and interpretation of results (CPT Manual©, 2020). 92579 can be used when obtaining responses via soundfield speakers, headphones, insert earphones, or a bone oscillator. 

Currently, no specific guidance is provided on a minimum number of responses needed to bill this code. In cases of uncertainty, clinicians should consider congruence with standard clinical practices when reporting this code. 92579 does include assessment of speech threshold, a standard of clinical practice when conducting VRA, and is therefore not customarily billed in combination with Speech Threshold Audiometry (92555). 

It is not recommended to bill 92579 in addition to other audiometric procedures such as Pure-Tone Audiometry (Threshold), Air Only (92552) or Air- and Bone-Conduction Audiometry (92553) because 92579 is valued as a stand-alone procedure.

92582 Conditioning Play Audiometry is used to obtain diagnostic audiometric results using a conditioned response procedure. Testing   can be conducted using a variety of transducers and should reflect standard clinical assessment practices. There is no stated requirement for a number of frequencies or  test conditions that are necessary to report 92582, relying instead on standards of practice. This code is described to be a bilateral procedure and includes pure-tone air- and bone-conduction testing.

The -52 reduced services modifier can be appended when testing unilaterally. There is currently no recommended CPT code or modifier to report when test assistance was provided by a second audiologist. When conducting more time-intensive speech tests, clinicians may choose to also report codes that best describe additional testing such as Speech Threshold Audiometry (92555), Select Picture Audiometry (92583), or Speech Audiometry Threshold with Speech Recognition (92556). 

When reporting these codes in addition to 92582, professionals should follow payer-specific guidance. Because 92582 is valued to include threshold testing, it is not recommended to bill this code as an add-on to Pure-Tone Audiometry (Threshold), Air Only (92552), or Air- and Bone-Conduction Audiometry (92553).

Speech Audiometry

Stand-alone speech audiometry procedures span three codes: Speech Threshold Audiometry (92555), Select Picture Audiometry (92583), and Speech Audiometry Threshold with Speech Recognition (92556). 

Professionals are cautioned not to double bill when combining with other procedures since these stand-alone codes may already be bundled together with other audiometry codes (e.g., Comprehensive Audiometry Threshold Evaluation and Speech Recognition (92557)). 

Mentioned earlier, there are instances where speech audiometry may be billed in addition to Conditioning Play Audiometry (92582). Clinicians are encouraged to check with payer policies first, as some payers may not accept these codes in combination. 

92555 Speech Threshold Audiometry is described as using standard clinical practices to obtain bilateral speech-awareness thresholds or speech-reception thresholds. Use of the -52 modifier is recommended when performing unilateral testing.

92556 Speech Audiometry Threshold with Speech Recognition includes two types of tests. The code description includes mirrored language from 92555, as well as additional word-discrimination testing. Similar to the other procedures discussed, this is also a bilateral procedure and the -52 modifier should be used when indicated.

92583 Select Picture Audiometry has a code description that primarily relies on standard clinical practices when reporting this type of testing. This procedure specifically includes speech-threshold testing, but may also include time spent on word discrimination using the same elicitation method.    

Electrophysiologic Audiometry: Auditory-Evoked Potentials

Auditory brainstem response (ABR) and auditory steady-state response (ASSR) audiometry are common electrophysiological exams used for recording auditory-evoked responses in the pediatric population. Both provide objective information about hearing sensitivity when reliable behavioral information is not able to be obtained.

Currently, there are two codes that describe ABR procedures, Auditory-Evoked Potentials (AEP) for Evoked-Response Audiometry, Limited (92586), and AEP for Evoked-Response Audiometry, Comprehensive (92585). These codes are available for billing pediatric AEP procedures but are somewhat limited in the specificity of their definitions to differentiate among neurodiagnostic, threshold-search, air-conduction, or bone-conduction testing. Furthermore, ASSR currently does not have a unique code for billing applications. 

This section will discuss and provide guidance regarding the use of these CPT© codes when filing claims for ABR testing.

92586 Auditory-Evoked Potentials (AEP) for Evoked-Response Audiometry, Limited is predominately used for hearing screenings by Universal Newborn Hearing Screening (UNHS) programs, or when assessing an objective pass/fail (refer) outcome. This code is also noted to be a bilateral procedure and should  be appended using the -52 modifier in the  case of unilateral testing.

92585 AEP for Evoked-Response Audiometry, Comprehensive is used for all other clinical or diagnostic auditory-evoked potential measures, including auditory steady-state response (ASSR), not pertaining to UNHS programs. 92585 is considered a bilateral, “session-based” code, meaning it may only be reported once per day per patient. 

For example, if both ABR and ASSR are performed on the same patient on the same day, you may only bill 92585 once. Appending the code with the -22 extended service modifier could be considered in situations where more extensive testing is performed. It is always best to check with payer policies first, as some payers, including many state Medicaid programs, do not acknowledge all modifiers.

Edits to CPT codes for AEP testing are forthcoming in January 2021, thanks to the diligent efforts of the Academy and volunteers from the Practice Policy Advisory Committee (PPAC), American Speech-Language-Hearing Association (ASHA), American Academy of Neurology, American Academy of Otolaryngology-Head and Neck Surgery, and American Clinical Neurophysiology Society. Until such time that the new guidance is released, the current codes as described above are recommended when billing AEP services.

Conclusion

Coding for pediatric audiology services is not always straightforward and ensuring that appropriate reimbursement is received for such services can be complicated. The recommended guidance provided in this article may vary from guidance from state Medicaid programs and third-party insurers. It is always advisable to review your state and local payer guidelines and follow payer policies to determine coverage prior to setting up billing protocols. 

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