Audiologists will have four new Current Procedural Terminology (CPT)* aural rehabilitation codes in 2006, following work done by the ASHA Health Care Economics Committee (HCEC). The new codes also apply to speech-language pathologists.
The new codes mark a change from the assessment of aural rehabilitation status as part of code 92506 and aural rehabilitation itself as part of CPT code 92507. The HCEC realized that procedure codes for diagnostic analysis of cochlear implant with programming (92601, 92602, 92603, 92604) created a need for procedure codes for reporting auditory rehabilitation procedures for children and adults. Since 1996, a single code (92510) had been used for both cochlear implant programming and aural rehabilitation following implantation. That was deemed redundant with the new cochlear implant diagnostic analyses and programming codes, and the code was eliminated.
The following questions and answers explain current coding for auditory rehabilitation.
Q: Is aural rehabilitation included in 92506 and 92507?
Aural rehabilitation is no longer included in the descriptor of either of these procedures although assessment of and treatment for auditory processing remains. Also, the American Medical Association (AMA) specifies that speech reading (lip reading) services should continue to be reported with code 92507.
Q: What is the difference between aural rehabilitation and auditory rehabilitation?
Auditory rehabilitation was selected as a broader, more encompassing term that could apply to many clinical activities. Where aural rehabilitation originally focused primarily on helping patients adjust to listening with hearing aids, including speech reading, recent years have brought many advances. Activities now include basic auditory and listening training for children who were unable to hear before receiving a cochlear implant, for adults with a hearing loss who do not wear hearing aids, and for children and adults who lost hearing and regained auditory function either with hearing aids or cochlear implants.
Q: What are the new codes for auditory rehabilitation evaluation?
- 92626: Evaluation of auditory rehabilitation status; first hour
- 92627: Each additional 15 minutes, on same day as 92626
Q: Can these auditory rehabilitation evaluation codes be used for patients considering a cochlear implant or hearing aid?
Yes. The AMA provides a further description of 92626: "The objective of this assessment is to determine current abilities to instruct the use of residual hearing provided by a cochlear implant or hearing aid. The assessment addresses, in children and adults, dimensions of impairment, activity limitation, participation restriction, and applicable environmental and contextual factors."
Q: Will other payers follow Medicare's lead regarding SLPs using 92507?
We do not know what the other payers will do, so it is best to check with each payer directly if you prefer to report 92507.
Q: What are the new codes for auditory rehabilitation? Why are there two of them?
- 92630: Auditory rehabilitation; pre-lingual hearing loss
- 92633: Auditory rehabilitation; post-lingual hearing loss
The AMA explains the appropriate application of both codes as follows:
- 92630: Pediatric (primarily): Services performed for patients who have no prior experience with hearing and are learning to hear through the use of hearing aids or a cochlear implants.
- 92633: Adults (primarily): Rehabilitation of adults who have received a cochlear implant after a long period of time during which they had no functional hearing to assist in achieving speech understanding and identification of sounds in a shorter time span.
Q: How does this relate to audiology services and Medicare?
Audiologists can bill Medicare for 92626 and 92627 because the services are diagnostic in nature. CMS limits coverage of services by audiologists who bill Medicare directly to diagnostic services only.
Q: What about the role of the SLP in auditory rehabilitation?
Speech-language pathologists may perform both assessment and intervention in auditory rehabilitation. It should be kept in mind that Medicare is clear that SLPs must use CPT 92507 for treatment services including auditory rehabilitation. They have not given instructions about the use of 92626 and 92627 (auditory rehabilitation evaluation) by SLPs. Thus, SLPs appear to have the option of using the new codes or 92506 for evaluation of auditory rehabilitation.