Coding and Reimbursement Overview
The American Academy of Audiology (the Academy) has an active role in establishing and/or revising Current Procedural Terminology (CPT®) codes for new/existing procedures relevant to the practice of audiology. The Academy has official Advisors to the American Medical Association’s (AMA) CPT process for the creation and revision of codes. In addition to the establishment of new codes, the Academy engages in the AMA Relative Value Scale (RVS) Update Committee (RUC) process for valuation of codes.
Once a category I CPT code is created, the Academy is involved in surveying the work and practice expense of the procedure, and present the findings to the RUC. The RUC’s recommendations are submitted to the Centers for Medicare and Medicaid Services (CMS), who makes the ultimate assignment of reimbursement values for the procedure under the Medicare Physician Fee Schedule (MPFS).
A full copy of the calendar and additional information from AMA can be found here.
Guidance to Industry and Individuals on Creating and Revising CPT Codes
If you are seeking to revise or create codes, please refer to the Academy’s “Guidance to Industry and Individuals on Creating and Revising CPT Codes.” The document includes a description of the AMA’s criteria for codes, followed by a series of questions to guide the development of a specific code proposal.
This section provides coding information and resources, such as billing templates, guidance on modifier usage, Medically Unlikely Edits and the National Correct Coding Initiative, to make sure that you correctly follow current procedures. You will also find answers to your most Frequently Asked Coding-Related Questions. An additional resource for addressing coding questions is the regular column in Audiology Today. A compilation of the coding articles from 2017-2021 is available for reference.
Have additional coding, reimbursement, or compliance questions? E-mail the Academy’s reimbursement mailbox. By submitting questions to the centralized mailbox, the Academy’s Coding and Reimbursement Committee (CRC) is able to review and discuss all inquiries posed to the Academy. This allows the CRC to research responses, identify trends in coding and reimbursement, develop coding and reimbursement resources, and engage in advocacy with payers regarding policies.
01/01/2021 (revised 04/06/2021)
The Academy’s Coding and Reimbursement Committee (CRC) has developed a list of ICD-10 coding information and resources for audiologists to use in their audiology practice.
Proposed Rule for 2024 MPFS and OPPS
July 19, 2023
On Thursday, July 13, the Centers for Medicare and Medicaid Services (CMS) posted proposed rules for both the 2024 Medicare Physician Fee Schedule (MPFS) and the 2024 Hospital Outpatient Prospective Payment System (OPPS).
New Audiology CPT Codes Introduced in 2021
The American Academy of Audiology (Academy) and the American Speech-Language-Hearing Association (ASHA) are pleased to announce the publication of seven new Current Procedural Terminology (CPT ®) codes for auditory-evoked potentials (AEP) and vestibular-evoked myogenic potential (VEMP) services. The American Medical Association (AMA) CPT Editorial Panel approved these codes for implementation on January 1, 2021.
CMS Expands List of Medicare Eligible Telehealth Providers to Include Audiologists
On April 30, 2020, the Centers for Medicare and Medicaid Services (CMS) issued an interim final regulation that states that all professionals who are able to bill Medicare for their professional services will be considered eligible telehealth providers for the duration of the COVID-19 public health emergency. Though not named specifically in the CMS Fact Sheet or Press Release, it is our interpretation of the regulation that audiologists are considered eligible providers of telehealth services.
COVID-19 Telehealth Update
April 3, 2020: As COVID-19 continues to impact individuals across the United States, the Department of Health and Human Services, state and local agencies, and commercial insurance programs are creating new and revised regulations/guidance regarding telehealth payment policies.
Audiologists are beginning to employ creative solutions to assist their patients while mitigating the risk of further transmission of the virus. Some former face-to-face visits are now being handled via telephone, video, and/or remote connection to hearing aid devices. Many audiologists are wondering if these remote services can be billed and reimbursed. This guide will help you understand options that are available to audiologists at the present time.