March 30, 2004 Feature

Bottom Line: Audiology Reimbursement for Auditory Processing Disorder

Audiologists face challenges in billing for auditory processing evaluation procedures because of a general third-party provision permitting providers to use a particular CPT code once only per date of service. ASHA is working with other audiology organizations to rectify this situation. The following are frequently asked questions about audiology reimbursement for auditory processing procedures.

Why is an auditory processing evaluation included in the same procedure code as a speech and language evaluation?

In 1995 ASHA submitted a request to the American Medical Association (AMA) Current Procedural Terminology (CPT*) Editorial Panel for an auditory processing evaluation code. At that time, the panel did not approve the new code but agreed with the need for recognition of auditory processing. The compromise was to include auditory processing as an element of CPT 92506, with the idea that this code would become a multidisciplinary access code.

This arrangement worked in the early years. But the Centers for Medicare and Medicaid Services (CMS) determined that CPT 92506 would be a speech-language pathology code because of its predominance of use for reporting speech and language evaluations in preparation for rehabilitation services. Unfortunately, many private party payers followed suit, in effect making CPT 92506 a non-reimbursable code for audiologists.

Why can't audiologists get paid when they use CPT 92506?

With a lack of access to CPT 92506, audiologists are left with only individual test codes:

  • CPT 92576, Synthetic Sentence Identification Test (SSI),
  • CPT 92572, Staggered Spondaic Word Test (SSW),
  • CPT 92571, Filtered Speech Test, and
  • CPT 92589, Central Auditory Function Test(s), specify. The original function of this code was to allow designation of any new procedures that came forward.

Audiologists have tried many different strategies to obtain reimbursement for their services in this area. Because of third-party restrictions, some audiologists have declared the auditory processing evaluation to be a non-covered procedure for which the family must pay directly.

Others have attempted to bill the three individual test codes in addition to CPT 92589 (billed either once or multiple times per date of service). Lastly, some audiologists bill the auditory processing evaluation under CPT 92700 (unlisted otorhinolaryngological service or procedure) and submit an accompanying report.

All of these billing strategies have met with some level of success depending on geographic location, third-party payer, and specific contract language. But for the majority, none of these procedures have proven effective for allowing recognition and appropriate reimbursement for an auditory processing evaluation.

What are the restrictions of use on CPT 92589?

The original intent of CPT 92589 was to permit specifying one or more auditory processing evaluation procedures, not otherwise listed, per date of service. The reality, however, is that a general third-party provision exists (with some exceptions) permitting the provider to use a particular CPT code only once per date of service.

How can audiologists bill for auditory processing services if no CPT codes exist that accurately reflect the services  they provide?

Unfortunately there is no universal answer to this question. From experience, some private payers will reimburse CPT 92506 for an auditory processing evaluation if prior authorization is obtained and it is very clear that the provider is an audiologist. Most HMOs will not reimburse. Audiologists that attempt third-party reimbursement may consider billing CPT 92506 or 92700 with report. The best guidance is for providers to speak with the health plan's customer service representative prior to providing the service to determine if this is a possibility, and under what circumstances.

What is ASHA doing to rectify this situation?

ASHA's Health Care Economics Committee has submitted an application for revision of CPT 92589 to the AMA and is scheduled to present this code at one of the AMA's upcoming meetings. ASHA also is collaborating with other audiology organizations to evaluate the possibility of modifying CPT 92589 so that it may be billed more than once per date of service. Other possibilities may include the development of a new code(s) to reflect the work, time, and practice expense associated with an auditory processing evaluation.

* CPT © 2004 American Medical Association. All Rights Reserved.

Robert Fifer , is associate professor in the department of pediatrics at the University of Miami School of Medicine. He is a member of ASHA's Health Care Economics Committee and serves as ASHA's representative to the American Medical Association Relative Value Update Committee.

cite as: Fifer , R. (2004, March 30). Bottom Line: Audiology Reimbursement for Auditory Processing Disorder. The ASHA Leader.

  

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