CMS Issues Final 2021 Hospital Outpatient Prospective Payment System Rule

CMS Issues Final 2021 Hospital Outpatient Prospective Payment System Rule

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. Status indicator “E1” is not paid by Medicare when submitted on outpatient claims. New CPT 92650 for 2021 (Aep scr auditory potential) has a status indicator of E1 and is not assigned to an APC.


Table 1:  APC 5721-Level I Diagnostic Tests and Related Services
(2018 final = $136.31)
(2019 final = $135.95)
(2020 final = $138.33)
(2021 final = $139.55)                                                                                                   

CPT Code

Code Descriptor

Status Indicator (SI) 2018 Final

2019 Final

2020 Final

2021 Final

92537*

Caloric vestibular test with recording, bilateral; bitherma (moved here from APC 5722)

S

         S

          S

             S

92538*

Caloric vestibular test with recording, bilateral; monothermal (moved here from APC 5722)

S

S

S

S

92540

Basic vestibular evaluation

S

S

S

S

92544

Optokinetic nystagmus test, bidirectional, foveal or peripheral stim, w/recordingp

S

S

S

S

92546

Sinusoidal vertical axis rotational testing

S

S

S

S

92584

Electrocochleography

S

S

S

S

92586

Auditory evoked potentials, limited (discontinued)

S

S

S

 

92601

Cochlear Implant initial programming <7 years old

S

S

S

S

92602

Subsequent programming <7 years old

S

S

S

S

92603

Cochlear implant initial programming > 7 years old

S

S

S

S

92604

 Subsequent programming >7 years old

S

S

S

S

92640

Auditory brainstem implant programming

S

S

S

S

92550

Tympanometry & reflex threshold

Q1

Q1

Q1

Q1

92553

Audiometry air and bone

Q1

Q1

Q1

Q1

92557

Comprehensive hearing evaluation

Q1

Q1

         Q1

            Q1

92562

Loudness balance test

Q1

Q1

Q1

Q1

92570

Acoustic immitance testing

Q1

Q1

Q1

Q1

92572

Staggered spondaic word test

Q1

Q1

Q1

Q1

92579

Visual audiometry (VRA)

Q1

Q1

Q1

Q1

92582

Conditioning play audiometry

Q1

Q1

Q1

Q1

92620

Auditory function test (60 min)

Q1

Q1

Q1

Q1

92625

Tinnitus assessment

Q1

Q1

Q1

Q1

92626

Evaluation of auditory rehab status

Q1

Q1

Q1

Q1

92651

Aep hearing status deter i&r NEW for 2021

 

 

 

S

92517

Vemp test i&r cervical - NEW 2021

 

 

 

S

92518

Vemp test i&r ocular- NEW 2021

 

 

 

S


Table 2:  APC 5722- Level II Diagnostic Tests and Related Services
(2018 final = $248.81)
(2019 final = $252.31)
(2020 final = $253.07)
(2021 final = $ 264.45)                                       

CPT Code

Code Descriptor

SI 2018 Final

2019 Final

2020 Final

2021 Final

92545*

Oscillating tracking test with recording (moved here from APC 5721)

S

S

S

S

92585

Auditory evoked potentials (ABR), comprehensive (discontinued)

S

S

S

 

92587

OAEs, limited

S

S

S

S

92588

OAEs, comprehensive

S

S

S

S

92519

Vemp tst i&r cervical&ocular NEW 2021

 

 

 

S

92652

Aep thrshld est mlt freq i&r NEW 2021

 

 

 

S

92653

Aep neurodiagnostic i&r NEW 2021

 

 

 

S


Table 3: APC 5723- Level III Diagnostic Tests and Related Services
(2018 final = $444.36)
(2019 final = $455.27)
(2020 final = $485.55)
(2021 final = $487.78)            

                                                                                                                          CPT Code

Code Descriptor

SI 2018 Final

2019 Final

2020 Final

2021 Final

92577

Stenger test, speech

Q1

Q1

Q1

Q1


Table 4: APC 5731- Level I Minor Procedures
(2018 final = $17.47)
(2019 final = $17.17)
(2020 final = $22.98)
(2021 final = $24.67)

CPT Code

Code Descriptor

SI 2018 Final

2019 Final

2020 Final

2021 Final

92564

SISI hearing test

Q1

Q1

Q1

Q1

92700

Unlisted otorhinolaryngological service or procedure

Q1

Q1

Q1

Q1

 


Table 5: APC 5732- Level II Minor Procedures
(2018 final = $31.80)
(2019 final = $32.12)
(2020 final = $33.43)  
(2021 final = $33.84)

CPT Code

Code Descriptor

SI 2018 Final

2019 Final

2020 Final

2021 Final

92555

Speech threshold audiometry

Q1

Q1

Q1

Q1

92563

Tone decay hearing test

Q1

Q1

Q1

Q1

92565

Stenger test, pure tone

Q1

Q1

Q1

Q1

92567

Tympanometry

Q1

Q1

Q1

Q1

92568

Acoustic reflex threshold

Q1

Q1

Q1

Q1

92571

Filtered speech test

Q1

Q1

Q1

Q1

92575

Sensorineural acuity test

Q1

Q1

Q1

Q1

92576

Synthetic sentence test

Q1

Q1

Q1

Q1

92596

Ear protection measurement

Q1

Q1

Q1

Q1


Table 6:  APC 5733 – Level III Minor Procedures *NEW assignment for two audiology codes in 2021
(2021 final = $55.66)

CPT Code

Code Descriptor

2021 Final

92556*

Speech threshold and discrimination (moved here from APC 5732)

Q1

92583*

Select picture audiometry (moved here from APC 5732)

Q1


Table 7: APC 5734- Level IV Minor Procedures
(2018 final =$105.03)
(2019 final = $106.48)
(2020 final = $109.02)
(2021 final = $111.95)

CPT Code

Code Descriptor

SI 2018 Final

2019 Final

2020 Final

2021 Final

92541

Spontaneous nystagmus test

Q1

Q1

Q1

Q1

92542

Positional nystagmus test

Q1

Q1

Q1

Q1

92548

Posturography

Q1

Q1

Q1

Q1

92552

Pure tone audiometry air

Q1

Q1

Q1

Q1

92561

Bekesy audiometry diagnosis

Q1

Q1

Q1

Q1


 

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