UPDATE: The deadline for use of the renewed ABN form has been extended to January 1, 2021.
OMB Updates Advance Beneficiary Notice of Noncoverage (ABN) Form CMS-R-131 (new form mandatory, effective August 31, 2020)
The Centers for Medicare and Medicaid Services (CMS) renewed the Advance Beneficiary Notice of Noncoverage (ABN) form, Form CMS-R-131. Use of this new form (expiration: 06/30/2023) will be mandatory effective, August 31, 2020. More information on the renewed ABN form can be found here.
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.
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.
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 2017-2018 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 concerning policies.
Learn about the ICD-10 Diagnosis Code Set on the ICD-10-CM web page.
News and Information
OMB updates Advance Beneficiary Notice of Noncoverage (ABN) Form CMS-R-131 (new form mandatory, effective August 31, 2020)
Coding for Evaluation of Auditory Rehabilitation Status (CPT codes 92626 and 92627), effective January 1, 2020
2015 Sample encounter form for diagnostic and rehabilitation procedures with ICD-9 codes and PQRS G codes
Order your coding manuals today!
Every audiologist should have a current CPT® book for procedural coding and an ICD-9-CM manual for information on medical diagnosis coding. For those dispensing hearing aids or supplies, the HCPCS codebook is essential. These resources are available from the American Medical Association as well as coding resource companies.
AMA Press Online
Phone Orders: 800-621-8335
- Coding and Reimbursement for ENT and Allergy
Academy Awarded Seat on CPT/HCPAC
The Academy has been awarded a seat on the AMA CPT/HCPAC, a panel of specialty societies charged with facilitating the review and development of applications for CPT codes used by qualified non-physician health care professionals. Read more ...
2011 Healthcare Common Procedure Coding System (HCPCS) codes
The 2011 HCPCS codes for cochlear implants (L8614-L8629), osseo-integrated devices (L8690-L8693) and hearing aids, supplies, assistive listening devices and some procedures (V5000-V5999) are listed in this document. Click here .
Vestibular CPT Codes Effective October 1, 2010
CPT codes 92541, 92542, 92544, and 92545 can now be filed separately if only two or three of these procedures are performed on the same date of service! Read more...
New Category III Codes for Automated Audiometry effective January 1, 2010.
The following Category III CPT codes that are to be utilized when performing the following tests with automated, computer-based equipment. Category III codes are temporary codes utilized for emerging technology, allowing for data collection to assess clinical efficacy, utilization, and outcomes (AMA 2010 CPT codebook). They must be reported instead of a Category I code, such as CPT 92557. While they are not listed in the 2010 CPT codebook, the following went into effect on January 1, 2010:
- 0208T: Pure tone audiometry ( threshold), automated (includes use of computer-assisted device); air only
- 0209T: air and bone
- 0210T: Speech audiometry threshold, automated (includes use of computer-assisted device)
- 0211T with speech recognition
- 0212T: Comprehensive audiometry threshold evaluation and speech recognition (0209T, and 0211T combined), automated (includes use of computer-assisted device)
New HCPCS Codes Effective January 1, 2010
In the 2010 HCPCS (Healthcare Common Procedure Coding System) manual, you will find one new osseointegrated device code, 3 new cochlear implant replacement parts codes, and a cochlear implant code descriptor:
- L8627-Cochlear implant, external speech processor, component, replacement
- L8628-Cochlear implant, external controller component, replacement
- L8629-Transmitting coil and cable, integrated, for use with cochlear implant device, replacement
- L8692-Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment
- L8619-Cochlear implant, external speech processor and controller, integrated system, replacement was changed from "Cochlear implant external speech processor, replacement"
New CPT Codes Effective January 1, 2010
In the 2010 CPT (Current Procedural Terminology) manual, you will find three new CPT Vestibular and Audiologic Function Tests codes. Similar to our other bundled code, 92557, these bundles are tests typically performed together and are now combined as one code. If all the procedures in one of the new bundles are performed, the new code is required to be utilized. For example, if you perform tympanometry (92567) and acoustic reflex testing, threshold (92568) as of January 1, 2010, you will no longer report them as 92567 and 92568 but will be required to report them with the new code, 92550. If you only perform 92567, you will still be able to bill 92567 alone. Read more...
As we transition to the new code set ICD-10-CM by October 1, 2014, this fact sheet provides general information about the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) including the benefits of adopting the new coding system and the differences between ICD-9-CM and ICD-10-CM/PCS.
New from the Centers for Medicare and Medicaid Medicare Learning Network (MLN): An Introductory Overview of the HIPAA 5010
The implementation of HIPAA 5010 presents substantial changes in the content of the data that providers submit with their claims, as well as the data available to them in response to their electronic inquiries. This Special Edition MLN Matters article alerts providers of these HIPAA changes and how they need to plan for their implementation. Click here. (PDF)
The transition to HIPAA 5010: CMS to Host First National Provider Education Call on June 9, 2009, 2:30-4:00 PM ET
The Centers for Medicare Medicaid Services (CMS) will host a national education conference call to address the implementation of HIPAA Version 5010. This will be a transition from the current HIPAA version 4010 and will be required for the electronic exchange of information as well as for the transition to ICD-10-CM. This call is for all Medicare providers and is a general overview of the 5010 transition. A presentation will be given, CMS Subject Matter Experts will be available to answer questions and a PowerPoint presentation will be posted on the CMS 5010 Web page prior to the call. Registration is required by 2:30 PM ET on June 8, and may be accessed here .
Getting Ready for the ICD-10-CM Transition… It's Not Too Early!
Providers may now register for the Centers for Medicare Medicaid Services' ICD-10-CM/PCS Implementation and General Equivalence Mappings (Crosswalks) National Provider Conference Call that will be conducted on May 19, 2009, from 1:00pm–2:30pm ET. Conference call discussion materials and registration information can be accessed on the CMS Web site.
A New CPT Code for 2009! Canalith Repositioning Procedure (CRP) Is CPT Code 95992.
This can be billed by an audiologist to any third-party payer with the exception of Medicare as it is considered a treatment code. The Academy, in conjunction with the American Speech-Language-Hearing Association (ASHA), the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), American Academy of Neurology (AAN), American Physical Therapy Association (APTA), and the American Chiropractic Association (ACA) worked collaboratively in creating this code.
HCPCS Code V5095's Decriptor Has Changed
Semi-implantable middle ear hearing prosthesis. The description "Use this code for Vibrant Soundbridge Implantable Middle Ear Prosthesis" was removed from the manual. We can look forward to new codes for 2010!
Correct Coding Initiatives Edits Were Released on January 1.
Correct Coding Initiatives (CCI) edits are released on January 1. CPT code 92531 (spontaneous nystagmus) and CPT code 92532 (positional nystagmus test) can no longer be reported on the same date of service with an Evaluation and Management code. To check for other CCI edits, visit the CMS Web site.
Information on Use of GY Modifiers:
- CMS Program Memorandum B-02-020, Coding for Non-Covered Services and Services Not Reasonable and Necessary (PDF)
- Empire Medicare Services News Brief, April/May 2002
Medically Unlikely Edits
- MUE Memo (June 19, 2006) (PDF)
The National Correct Coding Initiative (NCCI) Edits have been posted on the CMS Web site.