Q: How do you properly bill for diagnostic audiological testing which results in the fitting of hearing aids?
A: CMS has ruled that Medicare carriers may not automatically deny reimbursement for a hearing test because it results in a diagnosis of sensorineural hearing loss and fitting of a hearing aid. Medicare Program Memorandum (Transmittal B-01-34), effective May 29, 2001, states that Medicare coverage is determined by “the reason the tests were performed…rather than the diagnosis.” However, a physician referral is required for Medicare coverage.
Q: Is there any place that has information on coding for hearing aids?
A: The Health Care Procedure Coding System (HCPCS), National Level II manual, lists codes and descriptive terminology used to bill Medicare and other insurers for supplies, materials, and injections. HCPCS codes available for hearing services including hearing aids are listed as codes V5008 – V52999.
Q: We’ve had difficulty when billing for hearing aids. We are told that the codes billed for hearing aids are incorrect but are not told what is acceptable. What are the accepted “hearing aid” codes?
- For third party payers the rules are specific to each insurance company. Some of the CPT codes used include:
- 92590/1 – Hearing Aid Exam and Selection: Monaural/Binaural
- 92592/3 – Hearing Aid Check: Monaural/ Binaural
- 92594/5 – Electro-acoustic Evaluation: Monaural/Binaural
For insurance companies that provide hearing aids as a benefit, the provider should insist that the insurance company provide the codes to be used for the hearing aids, testing, services, supplies, etc. Some companies utilize HCPCS Level II codes. Only use these codes if/when the insurance company has authorized their use. Otherwise, insurance companies may refuse to reimburse a provider when these codes are submitted and denials will delay reimbursement. The implementation of HIPAA standard transaction code sets should alleviate this as an issue.
Q: Does the Academy have any recommendations for insurance companies regarding guidelines for hearing aid benefits or suggested allowance for reimbursement of hearing aids?
A: The Academy does not have a summarized document of recommendations, however, listed below are a few points that may be raised:
- Audiology services such as an audiologic evaluation, hearing aid evaluation, consultation and hearing aid follow-up visits should be covered separate from the devices.
- If a specified sum is provided for the coverage of hearing aids, balance billing the remaining balance for charges above the allotted sum shall be allowed. This may be applicable if the patient elects to obtain more advanced technology in order to meet their amplification needs.
- A binaural set of devices and hearing aid related services should be provided every 3 years.
- Customary and usual charges should determine costs for each audiologic service.
- Reimbursement rates should be reviewed at a minimum of every 2 years.
