New Payment Rates in Effect for Vestibular Codes
Last March, the American Academy of Audiology and the American-Speech-Language-Hearing Association worked in collaboration with the American Academy of Otolaryngology-Head and Neck Surgery and the American Academy of Neurology to survey the following vestibular Current Procedural Terminology (CPT) codes:
- 92541 Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording
- 92542 Positional nystagmus test, minimum of 4 positions, with recording
- 92543 Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes 4 tests), with recording
- 92544 Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording
- 92545 Oscillating tracking test, with recording
These surveys served to assess and revise the "professional work" value for each procedure. Professional work value includes factors such as mental effort and judgment, technical skill, and psychological stress. This is part of the valuation process established by the American Medical Association's Relative Value Update Committee (RUC). The payment rates published in this year's final rule reflect the first time that the values for these vestibular services, provided by audiologists, are based on the professional work components referenced above, a transition that began in 2007.
As part of the AMA RUC valuation process, the survey results garnered by each of the specialty societies are used by the AMA RUC to make recommendations to CMS. CMS accepted the RUC recommended values for 92541, 92542, 92544, and 92545, but did not accept the RUC recommended value for 92543 despite the advocacy efforts of the Academy and other stakeholders. Due to changes in time, equipment, and supplies, there was also a reduction in practice expense for the four other vestibular codes. Overall, CPT codes 92541, 92544, and 92545 will have lower reimbursement rates for CY 2015. These changes are detailed in the chart below:
|CPT Code||DESCRIPTION||CY 2014 Work RVU||CY 2015 Work RVU||CY 2014 PE RVU||CY 2015 PE RVU||CY 2014 Rate||CY 2015 Rate|
|92541||Spontaneous nystagmus test||0.40||0.40||0.44||0.21||$30.81||$22.55|
|92542||Positional nystagmus test||0.33||0.48||0.39||0.24||$26.51||$26.49|
|92543||Caloric vestibular test||0.10||0.10||0.33||0.33||$16.12||$16.11|
|92544||Optokinetic nystagmus test||0.26||0.27||0.39||0.15||$24.00||$15.75|
|92545||Oscillating tracking test||0.23||0.27||0.33||0.15||$20.78||$15.75|
The Academy is scheduled to meet with CMS in January to discuss the decrease in reimbursement for the vestibular codes.