In the era of COVID-19, it has become increasingly important to use different methods of clinical service provision to protect our patients’ health while still addressing their hearing, tinnitus, and vestibular health-care needs. 

As audiology clinics increase their use of telehealth as a method for patient care, audiologists must understand how such changes also impact coding and billing. This article will discuss considerations and provide examples of billing and coding for telehealth services for audiologists.

Insurance coverage for telehealth services varies based on payer. It is unlikely that payers will cover a service delivered through telehealth if it was not already recognized as a covered service. In other words, non-covered services will remain non-covered if provided via telehealth. For specific or atypical situations, it is recommended that professionals contact the payer directly to obtain guidance on coding and billing for services provided via telehealth.

TABLE 1. Commonly Used Place-of-Service Designations in Audiology

PLACE OF SERVICE

NAME

DESCRIPTION

Code 11

Office

Location, other than a hospital, skilled nursing facility, military facility, community health center, or state or local public health clinic where assessment, diagnosis, and treatment occurs on an ambulatory basis

Code 02

Telehealth

Location where services are provided through a telecommunication system

Telehealth Place-of-Service Codes and Modifiers

Health-care claim forms will typically have a space to indicate where the service took place. On the Centers for Medicare and Medicaid Services (CMS) 1500 health-care claim form, the place of service designation is reported in Box 24.b. 

TABLE 1 provides the place-of-service designations most pertinent to audiologists. 

  • Place-of-service code 11—Office is primarily used for typical face-to-face procedures provided in audiology offices. 
  • Place-of-service code 02—Telehealth indicates that the services were provided through a telecommunication system.

Some payers may use modifiers to indicate services were provided via telehealth. The only modifiers applicable for audiology services are Modifiers -95 (Telehealth) and -GT (Telehealth). 

On April 3, 2020, CMS provided guidance on appropriate reporting of telehealth services during the public health emergency (see Resources: CMS Guidance, Billing for Telehealth Services). Per CMS guidance, covered telehealth services should be reported using the appropriate procedure and diagnosis code(s), the normal in-person place of service (e.g., 11—Office), and the Modifier -95 to indicate the service was performed via telehealth. The Modifier -GT should only be reported when specifically instructed by the payer.

TABLE 2. CPT Codes for Telehealth When Provided by a Qualified Nonphysician Provider who Cannot Report E/M Services to Medicare

METHOD OF PATIENT INTERACTION

QUALIFYING CHARACTERISTICS

APPLICABLE PROCEDURE CODES (CHOOSE ONE)

ADDITIONAL CONSIDERATIONS

Nonphysician Telephone Services

  1. Non-face-to-face assessment/management provided over the telephone
  2. New or established patients
  3. Not related to episode of care within the last 7 days
  4. Not billed if telephone service results in decision to see the patient within 24 hours or soonest available appointment

98966 (5-10 min)

98967 (11-20 min)

98968 (21-30 min)

Applicable ICD-10 Codes

Choose code(s) to describe the reason for the encounter.

Consider encounter codes (e.g., Z46.1, Z45.32, Z97.4).

Place of Service

11 - Office or other normal office location

Nonphysician Online Digital Evaluation and Management (E/M) Services

  1. Patient-initiated through the electronic health record (EHR) portal, secure email, etc.
  2. New or established patients
  3. Require evaluation to inform management of the patient (mandatory E/M component)
  4. Billed once for cumulative time devoted during a seven-day period
  5. Documentation and permanent storage of encounter required

98970/G2061* (5-10 min)

98971/G2062* (11-20 min)

98972/G2063* (21+ min)

*G codes are exclusive to CMS; however, CMS does not cover G codes when provided by an audiologist; use the GY modifier. Other codes (i.e., 98970, 98971, 98972) are recommended for use among other payers. 

**Practitioners are strongly encouraged to contact payers to determine whether reporting of these codes by audiologists is appropriate.

Telehealth Codes

CMS approved the reporting of certain telehealth codes during the COVID-19 pandemic for certain practitioners who cannot bill Evaluation and Management (E/M) codes. These telehealth codes are presented in TABLE 2 (adapted from Resources: American Medical Association (AMA)). Readers should note that the codes provided in TABLE 2 may not be covered by Medicare or other payers when billed by audiologists. Audiologists are strongly encouraged to check with payer-specific guidance prior to reporting these codes.

TABLE 3. List of CPT Codes Added for Telehealth Provision (effective May 1, 2020)

CPT CODE

DESCRIPTION

ADDITIONAL CONSIDERATIONS

92601

Diagnostic analysis of CI, patient <7y, initial programming.              

If billing for procedures under non-facility rates, report regular in-person place of service (e.g., 11 - office) and Modifier -95
(telehealth) unless instructed otherwise by payer.

 

92602

Diagnostic analysis of CI, patient <7y, subsequent reprogramming                             

92603

Diagnostic analysis of CI, patient ≥7y, initial programming                  

92604

Diagnostic analysis of CI, patient ≥7y, subsequent reprogramming

Medicare

Because covered audiology services through Medicare Part B are currently limited to diagnostic procedures, examples of telehealth services covered under Medicare for hearing and balance care are few. A list of audiology services covered through Medicare is provided elsewhere (see Resources: CMS Guidance, Audiology Code List). TABLE 3 presents the current procedural terminology (CPT) codes that have been approved for telehealth provision as of May 1, 2020 (American Academy of Audiology (Academy), May 1, 2020).

For Medicare services that are never covered when provided by an audiologist, a voluntary Advance Beneficiary Notice (ABN) may be issued, but it is not required. More information regarding use of the ABN in audiology is provided in the Resources section (see Resources: Academy, ABN Quick Reference Guide). If the claim must be submitted to Medicare for denial, the GY or GY/GX modifier(s) would apply.

Insurers Other than Medicare

Insurance coverage policies for Medicaid, the Children's Health Insurance Program (CHIP), Medicare Advantage, and commercial insurance are discussed elsewhere (see Resources: Academy, COVID-19 Academy Resources). Practitioners are encouraged to seek telehealth coding and billing guidance directly from payers’ policy bulletins and websites. Clinicians should also reference payer-specific information when determining if a notice of non-coverage is    necessary for services provided via telehealth.

Services Not Covered (Self-Pay)

When insurers do not provide coverage, audiologists can furnish services remotely or via telehealth, as permitted through state licensure laws. As with other health-care goods or services not covered by the payer, these services can be paid directly by the patient. If the service is not covered by a third-party payer, audiologists would apply policies and customary fees they would normally use for a similar face-to-face, self-pay transaction.

FIGURE 1. Decision Matrix for Audiology Telehealth Services
FIGURE 1. Decision Matrix for Audiology Telehealth Services

Considerations for Practitioners and Case Examples

A decision matrix for audiology telehealth services is presented in FIGURE 1. This tool outlines general considerations when billing patients for audiology telehealth services: (1) Would there typically be a charge for the service if provided in the office? (2) Would we typically be reimbursed for providing that service by a third-party payer? Or, would this charge be the patient’s responsibility? Below we will discuss three case examples pertaining to audiology services provided using telehealth.

Case Example 1

A long-standing patient was scheduled for a binaural hearing aid check (92593) prior to the public health emergency. The hearing aid check and reprogramming was conducted remotely using a telecommunications system. Hearing aid checks and related services are included in the purchase price of the hearing aids, meaning, there is typically no charge for this appointment.

Because the clinic does not charge a fee for this appointment, we would perform the procedure as usual, but would not bill the patient for the service. 

Case Example 2

A patient was fitted with two hearing aids and was scheduled for a follow-up visit. Due to the public health emergency, they were unable to come into the office. Instead, the visit was conducted remotely and consisted of a binaural hearing aid check (92593). There is typically a fee for this service when provided in the office. The patient is a Medicare beneficiary without a secondary insurance. 

Because there is a customary fee for this service when provided in the office, we would also apply a fee for comparable services when provided through telehealth. Since the patient’s insurance, Medicare, does not include hearing aid services under covered services, we seek payment directly from the patient for the usual and customary fee of the 92593 service.

Case Example 3

An adult cochlear implant patient was seen for an initial programming session. Due to the public health emergency, the programming session was conducted by the audiologist via telehealth (synchronous audio and video) and use of remote-programming software. There is typically a fee for this service when provided in a face-to-face transaction. The patient is a Medicare beneficiary.

Because there is a customary fee for this service when provided in the office, we would also apply a fee for comparable services when provided through telehealth. Since the patient’s insurer, Medicare, covers cochlear implant programming codes when provided by audiologists via telehealth, we would choose the appropriate procedure code (here, 92603—Diagnostic Analysis of Cochlear Implant, seven years and older, initial programming) and diagnosis code(s). We would then use the -11 Office place-of-service designation and the Modifier -95 (Telehealth) to indicate that the service was provided remotely.

Conclusion

It is likely that the telehealth delivery model will remain even after the COVID-19 pandemic. As audiologists consider expanding their delivery model to include telehealth, there are many resources available for navigating coding and billing for these services. Updates and guidance from the Academy will be posted to the Academy's website. 

We encourage members to contact the American Academy of Audiology Coding and Reimbursement Committee at reimbursement@audiology.org with questions regarding the provision of audiology services via telehealth.  

*CPT codes, descriptions, and other data are Copyright 1966, 1970, 1973, 1977, 1981, 1983–2020 American Medical Association. All rights reserved. CPT© is a registered trademark of the American Medical Association.


Disclaimer

The purpose of the information provided above by the American Academy of Audiology Coding and Reimbursement Committee is strictly for educational guidance to audiologists. Action taken with respect to the information provided is an individual choice. The American Academy of Audiology hereby disclaims any responsibility for the consequences of any action(s) taken by any individual(s) as a result of using the information provided, and reader agrees not to take action against, or seek to hold, or hold liable, the American Academy of Audiology for the reader's use of the information provided. As used herein, the "American Academy of Audiology" shall be defined to include its directors, officers, employees, volunteers, members, and agents.