CODING AND REIMBURSEMENT | Auditory Function Evaluation and Computerized Dynamic Posturography: Codes and Payment Rates for 2020

By Erin L. Milller and Patricia Gaffney

This article is a part of the November/December 2019, Volume 31, Number 6, Audiology Today issue.

In late 2018, the American Academy of Audiology, in collaboration with the American-Speech-Language-Hearing Association (ASHA), the American Academy of Neurology (AAN), and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) surveyed the auditory function evaluation and computerized dynamic posturography codes at the request of the Centers for Medicare and Medicaid Services (CMS).

A description of the new and revised codes follows:

• CPT Code 92626: Evaluation of auditory function for candidacy or post-operative status of surgically implanted devices or other auditory treatment interventions; first hour.
• CPT Code 92627: Each additional 15 minutes (list separately in addition to code for primary procedure).
• CPT Code 92548: Computerized dynamic posturography sensory organization test (CDP-SOT), six conditions (i.e., eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway) including interpretation and report.
• CPT Code 92549: Computerized dynamic posturography sensory organization test (CDP-SOT), six conditions (i.e., eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway) including interpretation and report; with motor control test (MCT) and adaptation test (ADT).

In 2013, CMS identified CPT code 92626 for review due to a rapid increase in use. A coding brief was published in the CPT Assistant in July 2014 to clarify CPT code 92626 was to be used to report the evaluation of the auditory function of a patient either prior to or after receiving hearing devices, auditory osseo-integrated implants, middle-ear implants, and/or cochlear implant(s), or to monitor the progress of therapeutic intervention.

It was further clarified that the code was not intended for use for hearing aid examination, selection fitting and/or checking (codes 92590–92595, V5010–V5011), or diagnostic cochlear implant analysis and programming or subsequent reprogramming (codes 92601–92604).

CMS requested that the audiology associations review CPT code 92626 three years after the 2014 publication of the CPT Assistant coding brief as use continued to increase despite education efforts. At the October 2017 Relative Value Update Committee (RUC) meeting, the Academy and ASHA presented an action plan to bring this code back to CPT for revision and to clarify its intended use. The CPT Editorial Panel approved the code revisions in September 2018.