2020 OPPS Rule: Audiology Impacts

2020 OPPS Rule: Audiology Impacts

Tables 1-6 see below for APC assignments, status indicators, and reimbursement amounts for audiology codes. An “S” status indicator denotes a “Separate APC Payment” where regardless of services performed on the same date of service, the CPT code is paid at the APC rate. A “Q1” status indicator represents “STV-Packaged Codes” where APCs and CPT codes billed on the same date of service as those assigned a status indicator of “S”, “T” or “V” are packaged and not paid for separately. If billed without the “S,” “T,” or “V” service, payment is made at the APC rate. Status indicator “N” indicates payment is packaged into payment for other services, therefore no separate APC payment will be allowed.

Table 1: APC 5721-Level I Diagnostic Tests and Related Services (2018 final = $136.31)

(2019 final = $135.95)
(2020 proposed = $140.33)
(2020 final = $138.33)

CPT Code Code Descriptor Status Indicator 2018 Final Status Indicator 2019 Final Status Indicator 2020 Final
92537 Caloric vestibular test with recording, bilateral; bithermal* moved here from APC 5722 S S S
92538 Caloric vestibular test with recording, bilateral; monothermal* moved here from APC 5722 S S S
92540 Basic vestibular evaluation S S S
92544 Optokinetic nystagmus test, bidirectional, foveal or peripheral stim, w/recording S S S
92545 Oscillating tracking test, with recording S S S
92546 Sinusoidal vertical axis rotational testing S S S
92584 Electrocochleography S S S
92586 Auditory evoked potentials, limited S S S
92601 Cochlear Implant initial programming <7 years old S S S
92602 Subsequent programming <7 years old S S S
92603 Cochlear implant initial programming >7 years old S S S
92604 Subsequent programming >7 years old S S S
92640 Auditory brainstem implant programming S S S
92550 Tympanometry & reflex threshold Q1 Q1 Q1
92553 Audiometry air and bone Q1 Q1 Q1
92557 Comprehensive hearing evaluation Q1 Q1 Q1
92562 Loudness balance test Q1 Q1 Q1
92570 Acoustic immitance testing Q1 Q1 Q1
92572 Staggered spondaic word test Q1 Q1 Q1
92579 Visual audiometry (VRA) Q1 Q1 Q1
92582 Conditioning play audiometry Q1 Q1 Q1
92620 Auditory function test (60 min) Q1 Q1 Q1
92625 Tinnitus assessment Q1 Q1 Q1
92626 Evaluation of auditory rehab status Q1 Q1 Q1

 

Table 2: APC 5722-Level II Diagnostic Tests and Related Services (2018 final = $248.81)

(2019 final = $252.31)
(2020 proposed = $256.60)
(2020 final = $253.07)

CPT Code Code Descriptor Status Indicator 2018 Final Status Indicator 2019 Final Status Indicator 2020 Final
92585 Auditory evoked potentials (ABR), comprehensive S S S
92587 OAEs, limited S S S
92588 OAEs, comprehensive S S S

 

Table 3: APC 5723-Level III Diagnostic Tests and Related Services (2018 final = $444.36)

(2019 final = $455.27)
(2020 proposed = $486.65)
(2020 final = $485.55)

CPT Code Code Descriptor Status Indicator 2018 Final Status Indicator 2019 Final Status Indicator 2020 Final
92577 Stenger test, speech Q1 Q1 Q1

 

Table 4: APC 573-Level I Minor Procedures (2018 final =$17.47)

(2019 final = $17.17)
(2020 proposed = $23.57)
(2020 final = $ 22.98)

CPT Code Code Descriptor Status Indicator 2018 Final Status Indicator 2019 Final Status Indicator 2020 Final
92564 SISI hearing test* moved here from APC 5732 Q1 Q1 Q1
92700 Unlisted otorhinolarngological service or procedure Q1 Q1 Q1

 

Table 5: APC 5732-Level II Minor Procedures (2018 final = $31.80)

(2019 final = $32.12)
(2020 proposed = $34.33)
(2020 final = $33.43)

CPT Code Code Descriptor Status Indicator 2018 Final Status Indicator 2019 Final Status Indicator 2020 Final
92555 Speech threshold audiometry Q1 Q1 Q1
92556 Speech threshold and discrimination Q1 Q1 Q1
92563 Tone decay hearing test Q1 Q1 Q1
92565 Stenger test, pure tone Q1 Q1 Q1
92567 Tympanometry Q1 Q1 Q1
92568 Acoustic reflex threshold Q1 Q1 Q1
92571 Filtered speech test Q1 Q1 Q1
92575 Sensorineural acuity test Q1 Q1 Q1
92576 Synthetic sentence test Q1 Q1 Q1
92583 Select picture audiometry Q1 Q1 Q1
92596 Ear protection measurement Q1 Q1 Q1

 

Table 6: APC 5734-Level IV Minor Procedures (2018 final = $105.03)

(2019 final = $106.48)
(2020 proposed = $109.98)
(2020 final = $109.02)

CPT Code Code Descriptor Status Indicator 2018 Final Status Indicator 2019 Final Status Indicator 2020 Final
92541 Spontaneous nystagmus test Q1 Q1 Q1
92542 Positional nystagmus test Q1 Q1 Q1
92548 Posturography Q1 Q1 Q1
92552 Pure tone audiometry air Q1 Q1 Q1
92561 Bekesy audiometry diagnosis Q1 Q1 Q1

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