Vestibular Reimbursement

By Richard Gans, PhD


The American Academy of Audiology has clearly defined vestibular assessment and rehabilitation as within the scope of audiology practice [Position Statement, Audiology: Scope of Practice. Audiology Today, Vol. 9:2, 1997.]. Individual State Licensing Boards typically mirror these standards, with virtually all States with licensing specifying vestibular assessment and rehabilitation as within the audiologist scope of practice.

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!


Q: Are any codes available for Masking Device for Tinnitus?

A: In 2005, code 92625 was added to the CPT book to describe tinnitus assessment including pitch, loudness matching, and masking.

Tinnitus pitch testing measures the perceptual characteristics of self-perceived sounds. The quantification and documentation of self-perceived pitch are used to baseline information prior to treatment and to monitor the effectiveness of treatment.

The National Correct Coding Initiative

The Centers for Medicare & Medicaid Services (CMS) developed the National Correct Coding Initiative (CCI) to promote correct coding methodologies and to control improper coding that leads to inappropriate increased payment in Part B claims.

Skilled Nursing Facility

Q: We bill Medicare for diagnostic audiological services, which we provide in a Skilled Nursing Facility. We have had a claim denied for reason N73.

Physician Referrals

Q: Are diagnostic audiograms with physician referral a covered Medicare benefit? How does a diagnosis code affect reimbursement?

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.


Q: How do I obtain a denial from Medicare for a claim when the secondary payer requires one?

A. The "-GY" modifier should be appended to the CPT code to indicate an item or service that is statutorily excluded or does not meet the definition of any Medicare benefit. This is the code to use when seeking a "denial" for secondary purposes. Providers are mandated under the Medicare program to issue an Advance Beneficiary Notice (ABN) to patients if there is a reason to expect a reasonable and medically necessary denial.


Q: How do manufacturers get exclusive benefits with third party payers and why can't audiologists get the same recognition for the services they provide?

A: Certain manufacturers have been offering benefit deals for some time now. This is not an uncommon arrangement, whereby a provider offers discounted services to members of a benefit plan. Insurance companies like it because they are able to extend hearing benefits without any cost.

Incident-to Billing

"Incident to" services are defined as those services that are provided incident to physician professional services in the physician's office (whether located in a separate office suite or within an institution) or in a patient's home. To qualify as "incident to," services must be part of a patient's normal course of treatment, during which a physician performed an initial service and remains involved in the patient's treatment.