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. This article seeks to review collaborative guidance from the Academy, the Academy of Doctors of Audiology (ADA), and the American Academy of Audiology (AAA) on filing claims for pediatric audiometry. Coding for electrophysiologic measures, 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.
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.Valuation of this code considers work for obtaining responses, understanding that intense professional work may result in limited responses with difficult-to-test patients.
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).
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 speech-awareness thresholds or speech-reception thresholds.
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.
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.
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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