March 16, 2010 Audiology

New Audiology CPT Category III Codes

Audiologists now have five new Current Procedural Terminology© (CPT) codes related to automated audiometry. Payment for these CPT Category III codes, which became effective on Jan. 1, is based on the policies of payers and not on an annual fee schedule.

Audiologists routinely report CPT Category I codes for billing clinical services. These codes, such as 92557 (comprehensive audiometry), must meet the following Category I requirements:

  • Services or procedures are performed by many health care professionals across the country.
  • Approval for the procedure or service by the U.S. Food and Drug Administration is documented or imminent with a given CPT cycle.
  • The service or procedure has a proven clinical efficacy.
  • The service or procedure has relevance for research, either ongoing or planned.

In contrast, Category III codes cover "a set of temporary codes for emerging technology, services, and procedures" and are assigned an identifier that contains a letter in the last character. According to the American Medical Association (AMA), the "assignment of a CPT Category III code to a service does not indicate that it is experimental or of limited utility, but only that the service or technology is new and is being tracked for data collection."

Although the five new audiometric codes do not appear in the 2010 CPT Codebook, they may now be reported:

0208T, Pure tone audiometry (threshold),
automated; air only

0209T, Pure tone audiometry (threshold),
automated; air and bone

0210T, Speech audiometry threshold, automated;

0211T, Speech audiometry threshold, automated; with speech recognition

0212T,Comprehensive audiometry threshold evaluation and speech recognition (0209T, 0211T combined), automated

In response to an ASHA follow-up rationale to the AMA's CPT Editorial Panel, the AMA differentiated "automated" from "computer-assisted." Audiologists use many computer-assisted devices for procedures such as otoacoustic emissions and evoked potentials. The use of these devices requires the constant presence and vigilance of the audiologist to ensure appropriate data-gathering for test interpretation. In contrast, "automated" refers to equipment that follows a specified algorithm to determine what action to take next and does not require ongoing monitoring and vigilance by the clinician.

Audiologists should report these new Category III codes when automated audiometry is performed. Manual audiometric testing conducted by an audiologist or physician should be reported with codes 92551–92557. Bekesy audiometry codes 92560 and 92561 are also available when appropriate.

For a detailed description of the codes and policies, go to the American Medical Association's Web site [PDF]. For more information, contact reimbursement@asha.org.

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. (2010, March 16). New Audiology CPT Category III Codes. The ASHA Leader.

  

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