November 25, 2008 Bottom Line

Bottom Line: Coding and Reimbursement for Auditory Rehabilitation

For many years audiologists and speech-language pathologists have billed for auditory rehabilitation services—services described as aural rehabilitation or audiologic rehabilitation. The Current Procedural Terminology© (CPT) code descriptor will serve as a guide for this update regarding coding, coverage, and reimbursement of auditory rehabilitation.

Q: How and why have the CPT codes changed over the past five years?

Originally "aural rehabilitation" was included in the descriptor of speech-language pathology evaluation (92506) and speech-language pathology treatment (92507 individual and 92508 group). Audiologists found it difficult to receive reimbursement from private health plans because plans interpreted the codes as for use only by SLPs. ASHA collaborated with other audiology organizations and proposed deleting "aural rehabilitation" from 92506, 92507, and 92508 and creating new codes for auditory rehabilitation evaluation and auditory rehabilitation. The ASHA Health Care Economics Committee, with the help of audiologist Robert C. Fifer (University of Miami, Fla.), developed recommendations for new codes. In 2006 new CPT codes for auditory rehabilitation evaluation and auditory rehabilitation included:

  • 92626, evaluation of auditory rehabilitation status, first hour; 92627, each additional 15 minutes
  • 92630, auditory rehabilitation, prelingual hearing loss
  • 92633, auditory rehabilitation, postlingual hearing loss

Q: How does Medicare approach auditory rehabilitation?

Medicare covers auditory rehabilitation evaluation supplied by either audiologists or SLPs. Medicare does not recognize 92630 or 92633 because audiology is a diagnostic-only service under the statute. Medicare also prohibits SLPs from using these codes. SLPs can bill 92507 and 92508 even though "aural rehabilitation" is not in the descriptor.

Q: What are the Medicare relative values for auditory rehabilitation evaluation procedures?

Medicare uses the resource-based relative value scale to establish its annual physician fee schedule, which includes audiology and speech-language pathology procedures. Audiologists and SLPs can find Medicare fee schedules on the Billing and Reimbursement pages of the ASHA Web site.

Each procedure includes three components—professional (physician work), technical (practice expense), and professional liability (malpractice)—and each component receives relative value units (RVUs). In 2008, CPT 92626—auditory rehabilitation evaluation—has zero professional work RVUs, 2.10 practice expense RVUs, and 0.06 malpractice RVUs for a total of 2.16 RVUs.

The total is multiplied by the Medicare 2008 conversion factor of 38.0870 for a national fee of $82.27. Practitioners can check with their Medicare contractor for the local rates. The ASHA Medicare fee schedules include a link to the Centers for Medicare and Medicaid Services (CMS) Web site that allows local rate determinations.

The RVUs for 92627—each additional 15 minutes—are zero professional work RVUs, 0.50 practice expense RVUs, and 0.02 malpractice RVUs for a total of 0.52 RVUs. The total RVUs multiplied by the Medicare conversion factor result in a national rate of $19.81.

There are no RVUs for auditory rehabilitation procedures 92630 or 92633 because Medicare does not cover audiology treatment services.

Q: Will these procedures have a "professional work" component in the future?

We believe so. ASHA, the American Academy of Audiology, and the American Academy of Otolaryngology–Head and Neck Surgery presented recommended data for professional work to the American Medical Association RVU Update Committee (RUC). Following the RUC review, CMS will consider it for the 2010 Medicare Physician Fee Schedule. The audiologist's time is now included in the practice expense in the auditory rehabilitation evaluation procedures. The value for that time will be removed because it will be part of the professional component. The rehabilitation treatment codes will have no RVUs at all for Medicare.

Q: Do private health plans cover audiologists or SLPs providing auditory rehabilitation?

Each private health plan develops its own coverage position, often available on the Internet. For example, CIGNA posts its position 0180, which provides different coverage for audiology and speech-language pathology aspects of auditory rehabilitation and lists the four CPT codes described in this column. Aetna's clinical policy bulletin 0034 is somewhat cryptic and states that the company "considers aural rehabilitation medically necessary as speech therapy." Aetna lists the auditory rehabilitation codes but includes a related CPT code—69930, cochlear device implantation. Audiologists should contact ASHA (at reimbursement@asha.org) if they experience problems with private health plan coverage of auditory rehabilitation services.

Professionals may bill both 92507 (treatment of speech, language, voice—individual) and an auditory rehabilitation code if they are providing speech production and auditory training services during the same session.

Q: Aetna includes the cochlear implantation code. Does that mean that payers restrict coverage to services for those patients with cochlear implants and not hearing aids?

That should not be the case but coverage may be restricted to a change in the patient's hearing—that is, there is no pre-existing condition. We always recommend you contact the payer. When dealing with Medicare, contact the Medicare administrative contractor, fiscal intermediary, or carrier.

Steven C White, PhD, CCC-A, director of health care economics and advocacy, can be reached at swhite@asha.org.

cite as: White, S. C. (2008, November 25). Bottom Line: Coding and Reimbursement for Auditory Rehabilitation. The ASHA Leader.

  

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