Audiologists have a new Current Procedural Terminology (CPT)© code for canalith repositioning procedure (CRP) effective Jan. 1. Reimbursement for audiologists doing CRP remains inequitable, however, and ASHA is continuing to advocate for an appropriate work value for the procedure.
ASHA took the lead in developing the code, and then learned that the American Academy of Neurology was doing similar work. The two organizations began collaborating in February 2008 and were joined by the American Academy of Audiology and the American Academy of Otolaryngology–Head and Neck Surgery to finalize a submission to the American Medical Association (AMA) CPT Editorial Panel.
The CPT Editorial Panel accepted the proposal in 2008 and the AMA Relative Value Update Committee (RUC) assigned a 0.75 work relative value unit (RVU) to the procedure after receiving survey data from the four organizations.
The Centers for Medicare and Medicaid Services (CMS) assigned a work RVU of 0.75 for the service but determined that it would not be separately paid. CMS believes it is part of physician evaluation and management or a current physical therapy procedure that is paid for under a separate code.
Because audiology is a diagnostic test benefit under Medicare, CRP is non-reimbursable regardless of payment level. Only a revision in Medicare statute will allow audiology treatment services such as CRP to be covered.
CMS described actions that created the new code in the Federal Register (page 69896, Vol. 73, No. 224, Nov. 19, 2008):
The CPT Editorial Panel created and the AMA RUC valued a new code (CPT code 95992, Canalith repositioning procedure(s) (e.g., Epley maneuver, Semont maneuver), per day) for canalith repositioning, which is described as "therapeutic maneuvering of the patient's body and head designed to use the force of gravity. By using this type of maneuvering, the calcium crystal debris that is in the semi-circular canal system is redeposited into a neutral part of the end organ where it will not cause vertigo." This is a procedure that has been performed for several years. Previously this maneuver was billed by physicians as part of an E&M service and by nonphysician practitioners, primarily therapists, under a number of CPT codes, including 97112, Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities, which has 0.45 work RVUs. Therapists usually bill 2 units of service. The RUC recommended work RVUs for this service is 0.75. We believe a status indicator of ‘"B'' (Bundled Code, payments for covered services are always bundled into payment for other services not specified) is most appropriate because this service is currently being paid for as part of an E&M service. (Note: Because neurologists and physical therapists are the predominant providers of this service to Medicare patients (each at 22 percent) it has been assigned as a "sometimes therapy'' service under the therapy code abstract file.)"
ASHA responded to CMS, commenting that CMS should accept the RUC recommendation of 0.75 work RVUs for 95992. ASHA is concerned that audiologists billing this code to private payers or Medicaid would not be reimbursed due to the CMS bundled status of the code. In other words, the practitioner would receive 0.00 RVUs for the time and effort performing the procedure, translating to no payment by the third party.
ASHA's goal is for CMS to understand that canalith repositioning is not part of a CPT Evaluation and Management (E/M) procedure but might be a treatment recommendation as a result of an E/M of a dizzy patient. Canalith repositioning is a vital therapeutic procedure and is separate and distinct from standard evaluation and counseling. ASHA believes that the RUC recommendation of 0.75 RVUs for 95992 is equitable and should not be subsumed into an E/M or physical therapy code. If CMS revises its policy, it is more likely that other third-party payers will recognize the new CPT code and pay it according to the RUC recommended value.