CMS made significant revisions for contralateral routing hearing aid codes commonly known as CROS/BiCROS hearing devices (V5170 – V5240) effective January 1, 2019. The changes include the addition of 9 new codes and the revisions of 4 existing codes. The changes are an attempt to more accurately describe the current hearing aid technology used to treat patients with Single Sided Deafness and also patients with some degree of hearing loss in one ear and an unaidable hearing loss on the other side.
The original CROS/BiCROS codes were created in the 1980s to describe technology that is no longer available today. CROS and BiCROS hearing aids are no longer dedicated devices. Advancements in hearing aid technology allow for contralateral routing devices to be configured for a wide range of clinical applications.
The current codes create problems when working with insurance. The current CROS and BiCROS codes do not accurately describe to payers that the patient is receiving 2 devices (1 hearing aid and 1 contralateral routing device) regardless of degree of loss in the better ear. There also is currently no way to report when a single contralateral routing device is provided to a patient who wears an existing hearing aid on the opposite ear.
The original code change proposal application was submitted to CMS by the American Academy of Audiology (AAA), the American Speech-Language Hearing Association (ASHA), the Academy of Rehabilitative Audiology (ARA) and the Educational Audiology Association (EAA) and hearing aid industry manufacturer Phonak. CMS modified the original request, but we are hopeful that with aggressive payer and member education, the new and revised codes for 2019 will be beneficial.
The Academy’s Coding and Reimbursement Committee will be providing a series of member education and resources on this topic in the near future.
New Codes –
|V5171||Hearing aid, contralateral routing device, monaural, in the ear (ite)|
|V5172||Hearing aid, contralateral routing device, monaural, in the canal (itc)|
|V5181||Hearing aid, contralateral routing device, monaural, behind the ear (bte)|
|V5211||Hearing aid, contralateral routing system, binaural, ite/ite|
|V5212||Hearing aid, contralateral routing system, binaural, ite/itc|
|V5213||Hearing aid, contralateral routing system, binaural, ite/bte|
|V5214||Hearing aid, contralateral routing system, binaural, itc/itc|
|V5215||Hearing aid, contralateral routing system, binaural, itc/bte|
|V5221||Hearing aid, contralateral routing system, binaural, bte/bte|
These codes are intended to be used in reporting current contralateral routing technology.
Use the monaural codes when providing 1 contralateral routing device.
Use the binaural codes when providing 1 hearing aid and 1 contralateral routing device.
Revised Codes –
|V5190||Hearing aid, contralateral routing, monaural, glasses|
|V5200||Dispensing fee, contralateral, monaural|
|V5230||Hearing aid, contralateral routing system, binaural, glasses|
|V5240||Dispensing fee, contralateral routing system, binaural|
Use V5200 for dispensing 1 monaural contralateral routing device.
Use V5240 for dispensing 2 devices (e.g. binaural contralateral routing system, legacy CROS or BiCROS).
CMS recently updated the HCPCS file for CY2019. Codes V5170, V5180, V5210 and V5220 were deleted and should be discontinued for services on or after January 1, 2019. Reporting for all CROS and BiCROS services may be accomplished with the new HCPCS codes.
For inquires with regard to specific coding or individual coverage, please contact the payer directly for clarification. Information and a complete listing of all HCPCS codes for CY2019 may be accessed on the CMS website click here.
Disclaimer: While HCPCS codes are part of the standardized code set required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the use of HCPCS codes does not guarantee payment. You will need to check with your specific payors for their policy on these codes and devices.
On July 19, 2021, the Centers for Medicare and Medicaid Services (CMS) posted the proposed rule on the 2022 Hospital Outpatient Prospective Payment System. The Academy is reviewing the proposed rule for any policy changes that would affect the provision of audiology services in the outpatient setting. The Academy has calculated proposed reimbursement for audiology…
Late July 13, 2021, the Centers for Medicare and Medicaid Services (CMS) issued the proposed Medicare Physician Fee Schedule (MPFS) Rule for 2022. Based on an initial review of the proposed rule, below are some key provisions of interest to audiology. Conversion Factor The 2022 Medicare conversion factor is $33.5848, down from $34.8931. This is…
2022 Proposed Medicare Physician Fee Schedule – Initial Calculations of Proposed Payment Rates for Audiology Services
On July 13, 2021, CMS issued the Notice of Proposed Rule Making for the CY 2022 Medicare Physician Fee Schedule (MPFS). The Academy payment policy team has organized a chart of the proposed payment rates for audiology service (see “Current Resources”) based on initial calculations. Staff will continue analysis and post additional guidance. 7.13.21 CY…