Reimbursement

Reimbursement

Young boy receiving hearing test

CODING AND REIMBURSEMENT | Specialty Series: Pediatric Assessment

In January 2020, the American Academy of Audiology (the Academy) published its Clinical Guidance Document on the Assessment of Hearing in Infants and Young Children. The document covers four content areas: Pediatric Audiometry, Acoustic Immittance, Otoacoustic Emissions, and Electrophysiologic Audiometry. This article provides guidance on filing claims for pediatric audiometry and electrophysiologic audiometry. Coding for otoacoustic emissions and acoustic immittance are discussed elsewhere (Academy, Pediatric Audiology Billing & Coding Questions & Answers).

Topic(s): Coding, Reimbursement, reimbursment, Pediatric Assessment, Pediatric, Pediatric Audiology, pediatric audiometry, electrophysiologic audiometry, Behavioral Audiometry, Behavioral observation audiometry (BOA), visual reinforcement audiometry (VRA), conditioned play audiometry (CPA), Speech Threshold Audiometry, auditory brainstem response (ABR), auditory steady-state response

Academy Letter to Palmetto GBA: CPT 92557 Should Be Covered

The Academy recently wrote to Palmetto GBA, a Medicare Administrative Contractor, to express concerns regarding the Palmetto policy for reimbursement of tests on the same day a vestibular function study is performed.  

Specifically, Palmetto stated that only CPT 92552 (pure-tone audiometry threshold; air only) or CPT 92553 (air and bone) will be covered on the same day as a vestibular function study, but not CPT 92557 (comprehensive audiometry threshold evaluation and speech recognition). We argued that CPT 92557 should be covered.

From the back, a young boy working in school with cochlear implant

CODING AND REIMBURSEMENT | Specialty Series: Cochlear Implants

In July 2019, the American Academy of Audiology released its Clinical Practice Guidelines for Cochlear Implants (CIs) (Messersmith et al, 2019). Cochlear implantation is a surgical procedure for the treatment of severe to profound sensorineural hearing loss in both children and adults. 

Topic(s): Cochlear Implants (CI), Coding, Reimbursement

Message from the Academy Executive Committee

Message from the Academy Executive Committee

(March 22, 2020)

Work Together, Stay Informed, and Help Flatten the Curve

The message from the CDC and from your state and local governments is clear: The goal in navigating the COVID-19 pandemic at present is to flatten the curve. This means that containment of the COVID-19 virus is not possible, as you are aware from news reports. Without a vaccine or treatment, the only way to manage this with the health-care resources in the United States is to spread the number of infected people over time (flattening the curve).

This spreading out allows our health systems the bandwidth to care for ill people. In other words, if everyone is ill at the same time, more people will die because there is no way to provide enough care. If this same number of people are ill but enter the health-care system at different points over an extended period of time, the health-care system can more effectively manage care and many more people will survive.

The only way to flatten the curve is to practice social, or rather physical, distancing; literally to keep people physically away from each other. To this end, all “non-essential” businesses are being asked to “close.” Although this must happen no matter where a region is in terms of the virus, the sooner an area does this the better the result in terms of decreasing new cases of the virus and slowing the spread.


Many feel the concept of “non-essential” and “closed” are difficult depending on what you do and how you feel about what you do. Most people feel their business is essential for one reason or another. An “essential” business is defined as “life-sustaining.” This could be a hospital or a grocery store and will include businesses that supply groceries and resources for hospitals. There are other examples, but you get the idea. This means that without these businesses, lives would most likely be lost. “Closing” means closing your doors—not seeing anyone in person. It does not mean cutting off support from your customers/patients. The only way to flatten the curve is to stop people from interacting in person and one way to cut down on person-to-person contact is to close the doors of non-essential businesses.

Is providing support to individuals so they can hear and stay connected to loved ones during this time, access news reports and other important information, and support the hearing devices that may be worn by essential personnel (physicians, law enforcement, etc.) essential? Absolutely. However, the current need to keep people from face-to-face encounters requires that these services be provided creatively, using technology that allows physical distancing.

Audiology practices are “non-essential” in terms of the life-sustaining definition. We need to close our physical doors, so individuals do not come in person. As the CDC recommends, we need to all behave as if we already have this virus. We need to stay away from everyone and keep them away from us. But at the same time, we need to support our patients and provide the very essential care that promotes and supports communication. We must be innovative and figure out how to do this virtually. Some of you already do this and for others, you’ll need to gear up immediately. Virtual care can be as simple as making sure you update your website and signage on your door, so people know how to reach you by phone.

You can provide a tremendous amount of care virtually including trouble shooting non-functioning devices or suggesting amplification apps used with headphones that could help until a person can see you again. Perhaps mailing simple amplifiers to individuals in assisted living or skilled nursing whose hearing aids may not be functioning to help them communicate. You may have a first responder whose hearing aid is lost or damaged; you can manage this replacement without ever seeing this person at a time like this, it just takes some creativity.

The most important thing we can do to protect our patients right now is shut our physical doors and support them through telehealth mechanisms. I do not mean to imply this is easy or that this doesn’t have a tremendous cost to our practices. It does, but we must do no harm and we must be part of the solution that flattens this curve.

The Academy is engaged with Congress at this time requesting inclusion of reimbursement coverage of audiologists in the COVID-19 relief legislation. The Academy also has supported the language to include health-care providers in the small business loan proposals that are going before Congress. The staff and Academy leadership will be relentless in seeking legislative and regulatory solutions to support our members in private practice and other practice settings.

We must all work together to stay informed and seek innovations in practice during this time as we support the public health measures being recommended by the CDC and our local, state and national governments. For additional information, you may want to visit the Academy’s website for COVID-19 Clinical Recommendationsarticles on telehealth, including the Tele-audiology toolkit, and other COVID-19 resources

Stay at a distance, wash your hands, and don’t touch your face—the best advice the CDC can give at this time. Be well.

Sincerely,

Catherine Palmer, PhD, Academy President
Angela Shoup, PhD, Academy President-Elect
Lisa Christensen, AuD, Academy Past President
American Academy of Audiology Executive Committee

Academy Collaborates with Other Allied Health-Care Associations to Mitigate Coronavirus Impact on Members and Patients

The Academy is working with other allied health professional associations to identify actionable strategies to mitigate the coronavirus situation impact on members. Across the board, allied health professional associations are sharing concerns about the impact the current situation may have on small business healthcare providers as well as potential shortages of protective equipment such as masks and sanitizing products.

COVID-19 Resources

COVID-19 Resources

Academy Signs On to Multi-Stakeholder Letter Urging Recent Telehealth Changes Remain Permanent

The Academy signed on to a multi-stakeholder letter to House and Senate leadership urging action to avoid the telehealth “cliff” at the end of the public health emergency and make permanent expanded access to telehealth services in Medicare.  In addition, the letter urges Congress to ensure that HHS has the authority to add new providers to the list of eligible telehealth providers as well as to add new services as needed.

President’s Message: Health-Care Changes and Tele-Audiology—Our Focus on the Future

A crisis often shines a light on what is essential, and it has been clear that audiologists’ services in communication and balance are essential. A crisis provides a time to show patients and policymakers that audiologists are experts in this area. 

The Academy needs to focus on the changes that are happening in health care related to this crisis and formalize them and move them into the future to support audiologists’ ability to have accessible and appropriate care for patients.  

Virtual Academy Research Conference (ARC) 2020—Register Now!
Tele-Audiology: Theory to Practice

August 6, 10:00 am-5:00 pm ET

Leading experts in tele-audiology will share translational and applied research with a strong clinical focus. This meeting will consider the changing role of technology, patient engagement, and service-delivery in audiological care during COVID-19 and beyond.

Chaired by De Wet Swanepoel, PhD, professor, University of Pretoria, the program will feature a range of timely topics divided into the themes of the patient journey, assessment and intervention, and support and rehabilitation. 

National Audiology Associations Team Up to Request Removal of the Medicare Physician Order Requirement

The Academy of Doctors of Audiology (ADA), the American Academy of Audiology (the Academy), and the American Speech-Language-Hearing Association (ASHA) sent a joint letter to the Centers for Medicare and Medicaid (CMS) requesting the removal of the Medicare physician order requirement. 

Dietary Supplements Used for COVID-19 Treatment

Along with other professionals, audiologists must also be vigilant in their patient care—especially during their case history review— to counsel their patients about the extremely limited safety and efficacy information about dietary supplements as it pertains to COVID-19.

Newborn Hearing Screenings and Follow-Up: Essential During a Pandemic?

Learn more about the implications of the COVID-19 response on children who were born during the time when in-person health-care services were limited, focusing specifically on newborn hearing screening (NBHS) and follow-up services for infants identified with potential hearing loss.

 

COVID-19 Week in Review

See a recap of this week's news and resources. A new Academy update will be posted each Friday.


Practice Management Resources


Telehealth Resources

Telehealth and Medicare/Medicaid

Below is a resource list with information on the provision of telehealth services. The Academy will post additional information as it comes available.

Toolkits and Resource Centers


Treatment and Management Considerations

Ototoxicity, Medications, and Supplements


Government Resources


Public Awareness and Educational Resources


Communication Access Resources 


Free CEU-Eligible Online Education

The Academy is committed to ensuring audiologists have access to virtual educational resources during this challenging time. 

On-demand telehealth seminars are now available on eAudiology.org, and live webinars are scheduled throughout July. New webinars will be added each month. Please check the schedule of upcoming webinars to see the full list of offerings. Note: Content is free up to 30 days after live event and for live events only through July 31.

Brought to you by the AAA Foundation’s Educational Fund. Thank you to those who donated their AAA 2020 + HearTECH Expo Conference refunds toward this educational fund.


Mental Health


Resources for Students

Academy Comments to CMS Highlight Disproportionate Impact of Expected 2021 Medicare Payment Reductions on Audiology

The Academy submitted a letter  to CMS to supplement related comments submitted collectively with other physician and non-physician provider groups about the impact of the expected 2021 reimbursement reductions. The Academy letter highlights some of the nuances of these planned reductions in relation to providing audiological care. 

Illustrated image of a man standing in front of various signage showing different directions to take

CODING AND REIMBURSEMENT | Medicare QPP Rules for 2020

Under the final Quality Payment Program (QPP) rule for 2020, the Centers for Medicare and Medicaid Services (CMS) finalized a new Audiology Specialty Measure Set for audiology participation in the Quality category of the Merit-Based Incentive Payment System (MIPS) (2020 performance period/2022 payment year).

Topic(s): Coding, Reimbursement, Quality Payment Program (QPP), Medicare, Merit-Based Incentive Payment System (MIPS), Physician Quality Reporting System (PQRS), Medicare Physician Fee Schedule (MPFS), Centers for Medicare and Medicaid Services (CMS)

Author(s): 

Publication Issue: Audiology Today January/February 2020

Academy provides comments to CMS on proposed rules for the Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment System

The Academy submitted comments to the Centers for Medicare and Medicaid (CMS) on the proposed CY 2020 Medicare Physician Fee Schedule (PDF).  Academy comments provide specific feedback on Computerized Dynamic Posturography (CPT Codes 92548 and 92549) as well as on Auditory Function Evaluation (CPT Codes 92626 and 92627).  In addition, Academy comments urge CMS to reconsider its proposed restructuring of Evaluation and Management (E

Medicare Audiologist Access and Services Act of 2019 Introduced in the Senate

On September 9, 2019, U.S. Senators Elizabeth Warren (D-MA), Rand Paul (R-KY), Sherrod Brown (D-OH), and Roger F. Wicker (R-MS) introduced the Medicare Audiologist Access and Services Act of 2019 (S.2446).