American Speech-Language-Hearing Association
October 7, 2010

Medicare Vestibular Testing Payment Restrictions Lifted

This is a reminder that, as of October 1, 2010, erroneous Correct Coding Initiative (CCI) edits related to vestibular testing codes have been changed to allow Medicare billing for any combination of up to three of the following codes on the same date of service and without use of a modifier: 92541, 92542, 92544, and 92545. The CCI edits that originally went into effect January 1, 2010, had prevented billing of more than one vestibular testing code on the same day.

ASHA has received guidance from the Centers for Medicare and Medicaid Services (CMS) that any claims for services provided prior to October 1, 2010, that were affected by the original CCI edits (e.g., claims never submitted) can be billed and should be paid by the Medicare Administrative Contractor. However, it is our understanding that any claims that have already been submitted and denied based on the prohibitive CCI edits will not be appealable.

Note: The October 1, 2010 effective date applies only to services provided in an office setting. Outpatient facilities will not be able to take advantage of the change until January 1, 2011.

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