The topic of cochlear implants, middle-ear implants, and brain-stem implants is an active one in the coding and reimbursement of audiology and speech-language pathology evaluation and treatment services. Specific Current Procedural Terminology (CPT) codes are related to testing and rehabilitation for prospective implant patients and patients who have received an implant. Robert Fifer and other members of ASHA's Health Care Economics Committee have drafted and defended CPT proposals to the American Medical Association CPT Editorial Panel to ensure that appropriate codes are available to audiologists and speech-language pathologists to report auditory implant device-related procedures. These questions and answers focus on coverage and procedural coding of these services.
Q: I am an audiologist and am seeing a Medicare beneficiary for auditory rehabilitation following a cochlear implant. Can I bill Medicare for CPT 92633 (auditory rehabilitation; postlingual hearing loss)?
No. Medicare covers only diagnostic audiology services. The Medicare statute needs to be amended to permit audiologists to bill for rehabilitation services. ASHA is working to accomplish that goal.
Q: I am an SLP and work in a hospital. Can the hospital bill Medicare for CPT 92633 (auditory rehabilitation; postlingual hearing loss) when I provide the procedure?
No. Although SLPs can provide Medicare rehabilitation services, the Centers for Medicare and Medicaid Services (CMS) made the decision not to cover 92633—and also not to cover CPT 92630, auditory rehabilitation; prelingual hearing loss—to clarify that audiologists could not bill for the procedure. CMS instructs SLPs providing auditory rehabilitation to Medicare beneficiaries to use CPT 92507 (treatment of speech, language, voice, communication, and/or auditory processing).
Q: Can the hospital, my employer, bill a private health plan (e.g., an employer-sponsored health plan) for CPT 92633 when I provide the service? I'm an SLP.
The hospital definitely can bill a private health plan for CPT 92633. Only Medicare disallows CPT 92633. You may want to check the health plan's Web site to ensure that 92633 is included in its medical policy. For example, Cigna has a Healthcare Coverage Position (0180) that specifically lists 92630 and 92633 as covered procedures when medically necessary (search "aural rehabilitation" on Cigna's Web site). The summary of the Cigna coverage position states, "AR is indicated for the treatment of such impairment and is a medically necessary component of the management of cochlear device and auditory brainstem implantation."
Q: As an audiologist in private practice, can I bill a private health plan (e.g., an employer-sponsored health plan) for CPT 92633 when I provide the service?
Yes, you can bill a private health plan for CPT 92633. Only Medicare disallows CPT 92633. As stated above, you may want to check the health plan's Web site to ensure that 92633 is included in its medical policy. The Cigna policy is a good one for you to review to see how private health plans view AR.
Q: I am a private-practice audiologist and have a Medicare provider number. What CPT code should I use when seeing a 15-year-old patient who has just had a cochlear implant?
The code for this situation is CPT 92603 (diagnostic analysis of cochlear implant, age 7 years or older; with programming). For follow-up services you can use CPT 92604 (subsequent reprogramming).
Q: I recently took a position as an audiologist in an auditory implant center. Is there a code for programming an auditory brainstem implant? I know Medicare covers the surgery.
The correct code is CPT 92640 (diagnostic analysis with programming of auditory brainstem implant, per hour).