On April 1, 2012, the National Correct Coding Initiative (NCCI) edits for (central) auditory processing evaluations go into effect. While enforcement of the edits is new, the practice of grouping certain codes to bill for (central) auditory evaluations should already be established by most clinicians.
Since the development of Current Procedural Terminology (CPT) Codes 92620 (evaluation of central auditory function, with report; initial 60 minutes) and 92621 (each additional 15 minutes) in 2005, it has been recommended that these codes not be billed in combination with certain codes: 92571 (Filtered Speech Test), 92572 (Staggered Spondaic Word Test), and/or 92576 (Synthetic Sentence Identification Test). When the individual test procedures (92571, 92572, or 92576) are performed in isolation, then the single code representing that procedure can still be reported. However, when a battery of tests is performed, the clinician should not bill for individual tests in addition to 92620/92621. Using the time-valued codes of 92620/92621, the audiologist can capture the time spent on the evaluation for site of lesion and other tests of (central) auditory function. Further, billing 92620/92621 does not imply that the three individual tests are part of the battery of tests used to evaluate central auditory function, but allows the audiologist to determine the tests most appropriate for the patient.
Enforcement of the NCCI edits on April 1, 2012, means audiologists can no longer bill for Codes 92620/92621 with Codes 92571, 92572, or 92576 on the same day for Medicare or Medicaid services.
For updates and additional NCCI edits, visit ASHA's webpage or contact Lisa Satterfield, ASHA's director of health care regulatory advocacy, at firstname.lastname@example.org with any questions or concerns.