CMS Issues Final 2021 Hospital Outpatient Prospective Payment System Rule

Tables 1-6 see below for APC assignments, status indicators, and reimbursement amounts for audiology codes.  An “S” status indicator denotes a “Separate APC Payment” where regardless of services performed on the same date of service, the CPT code is paid at the APC rate. A “Q1” status indicator represents “STV-Packaged Codes” where APCs and CPT codes billed on the same date of service as those assigned a status indicator of “S”, “T” or “V” are packaged and not paid for separately. If billed without the “S,” “T,” or “V” service, payment is made at the APC rate. Status indicator “N” indicates payment is packaged into payment for other services, therefore no separate APC payment will be allowed. Status indicator “E1” is not paid by Medicare when submitted on outpatient claims. New CPT 92650 for 2021 (Aep scr auditory potential) has a status indicator of E1 and is not assigned to an APC.

Table 1:  APC 5721-Level I Diagnostic Tests and Related Services

(2018 final = $136.31)

(2019 final = $135.95)

(2020 final = $138.33)

(2021 final = $139.55)    

CPT Code	Code Descriptor	Status Indicator (SI) 2018 Final	2019 Final	2020 Final	2021 Final
92537*	Caloric vestibular test with recording, bilateral; bitherma (moved here from APC 5722)	S	S	S	S
92538*	Caloric vestibular test with recording, bilateral; monothermal (moved here from APC 5722)	S	S	S	S
92540	Basic vestibular evaluation	S	S	S	S
92544	Optokinetic nystagmus test, bidirectional, foveal or peripheral stim, w/recordingp	S	S	S	S
92546	Sinusoidal vertical axis rotational testing	S	S	S	S
92584	Electrocochleography	S	S	S	S
92586	Auditory evoked potentials, limited (discontinued)	S	S	S
92601	Cochlear Implant initial programming <7 years old	S	S	S	S
92602	Subsequent programming <7 years old	S	S	S	S
92603	Cochlear implant initial programming > 7 years old	S	S	S	S
92604	Subsequent programming >7 years old	S	S	S	S
92640	Auditory brainstem implant programming	S	S	S	S
92550	Tympanometry & reflex threshold	Q1	Q1	Q1	Q1
92553	Audiometry air and bone	Q1	Q1	Q1	Q1
92557	Comprehensive hearing evaluation	Q1	Q1	Q1	Q1
92562	Loudness balance test	Q1	Q1	Q1	Q1
92570	Acoustic immitance testing	Q1	Q1	Q1	Q1
92572	Staggered spondaic word test	Q1	Q1	Q1	Q1
92579	Visual audiometry (VRA)	Q1	Q1	Q1	Q1
92582	Conditioning play audiometry	Q1	Q1	Q1	Q1
92620	Auditory function test (60 min)	Q1	Q1	Q1	Q1
92625	Tinnitus assessment	Q1	Q1	Q1	Q1
92626	Evaluation of auditory rehab status	Q1	Q1	Q1	Q1
92651	Aep hearing status deter i&r NEW for 2021				S
92517	Vemp test i&r cervical – NEW 2021				S
92518	Vemp test i&r ocular- NEW 2021				S

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Table 2:  APC 5722- Level II Diagnostic Tests and Related Services

(2018 final = $248.81)

(2019 final = $252.31)

(2020 final = $253.07)

(2021 final = $264.45) 

CPT Code	Code Descriptor	SI 2018 Final	2019 Final	2020 Final	2021 Final
92545*	Oscillating tracking test with recording (moved here from APC 5721)	S	S	S	S
92585	Auditory evoked potentials (ABR), comprehensive (discontinued)	S	S	S
92587	OAEs, limited	S	S	S	S
92588	OAEs, comprehensive	S	S	S	S
92519	Vemp tst i&r cervical&ocular NEW 2021				S
92652	Aep thrshld est mlt freq i&r NEW 2021				S
92653	Aep neurodiagnostic i&r NEW 2021				S

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Table 3: APC 5723- Level III Diagnostic Tests and Related Services

(2018 final = $444.36)

(2019 final = $455.27)

(2020 final = $485.55)

(2021 final = $487.78)            

CPT Code	Code Descriptor	SI 2018 Final	2019 Final	2020 Final	2021 Final
92577	Stenger test, speech	Q1	Q1	Q1	Q1

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Table 4: APC 5731- Level I Minor Procedures

(2018 final = $17.47)

(2019 final = $17.17)

(2020 final = $22.98)

(2021 final = $24.67)

CPT Code	Code Descriptor	SI 2018 Final	2019 Final	2020 Final	2021 Final
92564	SISI hearing test	Q1	Q1	Q1	Q1
92700	Unlisted otorhinolaryngological service or procedure	Q1	Q1	Q1	Q1

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Table 5: APC 5732- Level II Minor Procedures

(2018 final = $31.80)

(2019 final = $32.12)

(2020 final = $33.43)  

(2021 final = $33.84)

CPT Code	Code Descriptor	SI 2018 Final	2019 Final	2020 Final	2021 Final
92555	Speech threshold audiometry	Q1	Q1	Q1	Q1
92563	Tone decay hearing test	Q1	Q1	Q1	Q1
92565	Stenger test, pure tone	Q1	Q1	Q1	Q1
92567	Tympanometry	Q1	Q1	Q1	Q1
92568	Acoustic reflex threshold	Q1	Q1	Q1	Q1
92571	Filtered speech test	Q1	Q1	Q1	Q1
92575	Sensorineural acuity test	Q1	Q1	Q1	Q1
92576	Synthetic sentence test	Q1	Q1	Q1	Q1
92596	Ear protection measurement	Q1	Q1	Q1	Q1

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Table 6:  APC 5733 – Level III Minor Procedures *NEW assignment for two audiology codes in 2021

(2021 final = $55.66)

CPT Code	Code Descriptor	2021 Final
92556*	Speech threshold and discrimination (moved here from APC 5732)	Q1
92583*	Select picture audiometry (moved here from APC 5732)	Q1

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Table 7: APC 5734- Level IV Minor Procedures

(2018 final =$105.03)

(2019 final = $106.48)

(2020 final = $109.02)

(2021 final = $111.95)

CPT Code	Code Descriptor	SI 2018 Final	2019 Final	2020 Final	2021 Final
92541	Spontaneous nystagmus test	Q1	Q1	Q1	Q1
92542	Positional nystagmus test	Q1	Q1	Q1	Q1
92548	Posturography	Q1	Q1	Q1	Q1
92552	Pure tone audiometry air	Q1	Q1	Q1	Q1
92561	Bekesy audiometry diagnosis	Q1	Q1	Q1	Q1