Audiologists often call ASHA with questions on coding and reimbursement for audiological services involving tinnitus evaluation and intervention. The following Q&A answers the most common questions.
Q: Which International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes should be used for tinnitus?
ICD-9-CM 2009 codes for tinnitus are 388.30: tinnitus, unspecified; 388.31: subjective tinnitus; and 388.32: objective tinnitus.
Q: Which Current Procedural Terminology (CPT)® code should be used for tinnitus assessment?
Use CPT code 92625: assessment of tinnitus (includes pitch, loudness matching, and masking).
Q: What are these tinnitus assessment components?
Pitch (frequency) matching is intended to match the stimulus closest in pitch to the patient's tinnitus. Loudness matching testing is performed to obtain loudness matches between the audiometric stimulus and the patient's tinnitus. The masking procedure involves determination of the minimum masking level (MML) and testing for tinnitus suppression (residual inhibition). If only one ear is tested using the tinnitus assessment procedure, the modifier -52 (reduced service) should be applied. This modifier would also be used if only part of the tinnitus assessment battery is performed.
Q: Which CPT code should be used when evaluating a client with a tinnitus masker?
You can consider using CPT 92590 (hearing aid examination and selection: monaural) or 92591 (hearing aid examination: binaural).
Q: How do I code the masker itself?
A tinnitus masker could be coded using Level II Health Care Procedure Coding System National Codes (HCPCS), which are required for reporting most medical services and supplies provided to Medicare and Medicaid patients and by most private payers. There is not a code for a tinnitus masker, but V5299 is for hearing service, miscellaneous. HCPCS instructions note that this code should be used only if a more specific code is unavailable. Hearing services fall under V5000–V5999.
Q: Can the various interventions used for the treatment of tinnitus be reimbursed?
Most third-party payers view tinnitus treatment claims based on the procedure. For example, Aetna's Clinical Policy Bulletin 0406 states that Aetna considers transcutaneous electrical nerve stimulation (TENS) medically necessary durable medical equipment (DME) for members with severe tinnitus when all of the following criteria are met: "(1) Member has experienced severe tinnitus for more than 6 months, and (2) Medically correctable causes of tinnitus have been ruled out, and (3) Member has tried and failed conservative tinnitus treatments, including counseling and reassurance, dietary modifications, and drug therapy." Aetna limits coverage to no more than 10 TENS sessions per year "because of a lack of evidence that more frequent TENS treatments provides additional clinically significant benefits for this condition." Aetna denies coverage for tinnitus instruments, ear canal magnets and electromagnetic stimulation, and tinnitus retraining therapy because they are experimental, investigational, or the effectiveness has not been established.
Medicare will cover a tinnitus evaluation performed by an audiologist if the patient is referred by a physician. However, Medicare states in its Coverage Issues Manual that tinnitus masking is considered "an experimental therapy" and does not cover that procedure.
Q: Is there no specific CPT code for tinnitus intervention?
That's correct. There is no such code. For tinnitus intervention you can consider using 92507: treatment of speech, language, voice, communication, and/or auditory processing disorder, individual. CPT code 92633: auditory rehabilitation, postlingual hearing loss, does not include tinnitus intervention.
Q: Where can I find more information about CPT codes and HCPCS?
A good place to start is the ASHA Web page on billing and reimbursement; it includes a specific section on coding. The American Medical Association (AMA) CPT and HCPCS books are available through the AMA Press. The Coders' Desk Reference, designed for the lay person, is available through Ingenix Companies (800-765-6588). ASHA's Private Health Plans Handbook also has a list of the CPT codes commonly used by members, and is available through ASHA Product Sales.