American Speech-Language-Hearing Association
July 30, 2010

Medicare Vestibular Testing Payment Restrictions Will be Lifted on October 1

Audiologists, otolaryngologists, and neurologists gained a victory today after months of lobbying to get erroneous coding edits revised. The Centers for Medicare and Medicaid Services (CMS) will correct the National Correct Coding Initiative (NCCI) edits effective October 1, 2010, related to vestibular testing codes 92541, 92542, 92544, and 92545. The CCI edits will allow Medicare billing of combinations of 3 or less of codes 92541, 92542, 92544, and 92545. CMS wrote that, "If two or three of these codes are reported for the same date of service by the same provider for the same beneficiary, an NCCI-associated modifier may be utilized to bypass the NCCI edits." ASHA is seeking clarification about the practitioners and the outpatient facilities edits and their specific modifications. It seems clear that the practitioners revision will become effective on October 1, 2010, but it is not as clear for the outpatient facilities. We are also requesting clarification regarding the correct NCCI-modifier to use when reporting the codes to Medicare.

The American Medical Association (AMA) Current Procedural Terminology (CPT) errata page posted corrections [PDF] on July 22, 2010, that describe the appropriate reporting of the individual vestibular testing codes. The following is their notice of editorial corrections for parentheticals following codes 92541, 92542, 92544, 92545, with the additional language "92540 or the set of...and 92545."

  • "92541 Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording — (Do not report 92541 in conjunction with 92540 or the set of 92542, 92544, and 92545.)
  • 92542 Positional nystagmus test, minimum of 4 positions, with recording — (Do not report 92542 in conjunction with 92540 or the set of 92541, 92544, and 92545.)
  • 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 — (Do not report 92544 in conjunction with 92540 or the set of 92541, 92542, and 92545.)
  • 92545 Oscillating tracking test, with recording — (Do not report 92545 in conjunction with 92540 or the set of 92541, 92542, and 92544.)
  • 92546 Sinusoidal vertical axis rotational testing."

Please address questions or comments to reimbursement@asha.org.


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