Audiologists have a new code for otoacoustic emission (OAE) screening and revised codes for OAE evaluation under the 2012 Current Procedural Terminology (CPT; © American Medical Association), effective Jan. 1, 2012.
New code 92558 is for "Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis." New descriptors for current OAE codes, 92587 and 92588, are differentiated by the number of frequencies performed.
The codes are listed in the 2012 CPT Codebook in sequence (even though 92558 does not immediately precede the other two codes), and include the Medicare Physician Fee Schedule national payment rates. The actual payment will be adjusted by the relevant geographic index.
Audiologists should use 92558 when performing an automated pass/fail screening via a fixed number of limited frequencies at a single intensity level. (A screening may be administered by support personnel, an audiologist, or a physician.)
CPT 92558 was not assigned a payment rate because, as a screening code, it is assigned an "N" (not covered) status by Medicare. CPT 92558 may require a -33 modifier when the procedure is preventive and part of a newborn hearing loss screening program (see the American Medical Association website [PDF]).
Audiologists should consult the specific guidance provided by state and federal payers, such as Medicare area contractors and Medicaid, as well as by private third-party payers. Some may dictate the use of specific codes, modifiers, and coverage determinations specific to a state or place of service.
Hospital providers should consult their billing departments as to the appropriate use of these codes.
CPT 92587 is used for distortion product evoked otoacoustic emissions, limited evaluation (to confirm the presence or absence of hearing disorder, 3–6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report.
CPT 92587 is to be used when three to six frequencies are tested bilaterally. Audiologists performing distortion product and transient evoked otoacoustic emissions may file the claim for 92587 with the -22 modifier (increased procedural service) to indicate the additional test, but this coding may not be acceptable to some payers. A report is required to document the test results.
CPT 92588 is used for comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and a report.
Audiologists should use this code when at least 12 frequencies are tested bilaterally. If fewer than 12 frequencies are performed, the appropriate code is 92587. A report is required to document the test results; a printout from the equipment does not constitute a report.
Audiologists with questions about the ability of equipment to perform multiple frequencies and intensities should consult the OAE equipment manufacturer or equipment service provider for guidance. The ability to use a specific code may be restricted by equipment limitations (e.g., not performing 92588 if the equipment does not have 12 frequencies).
Both evaluation codes—92587 and 92588—comprise a technical component (TC) and a professional component (PC). When an audiologist performs the complete service (i.e., both the PC and TC), no modifier is needed.
Under Medicare, OAE testing may be performed by a technician working under the direct supervision of a physician who provides the interpretation (professional component). However, Medicare stipulates that a technician may not perform OAE testing under the supervision of an audiologist; therefore, services performed by a technician for Medicare beneficiaries cannot be billed under the National Provider Identifier of an audiologist.
- Using the 2011 conversion factor, the non-facility payment rate for CPT 92587 is $28.20; of that, $18.01 is PC and $10.19 is TC.
- Using the 2011 conversion factor, the non-facility payment rate for CPT 92588 is $42.81; of that, $28.20 is PC and $14.61 is TC.
The 2012 conversion factor is scheduled to be reduced by about 27%; however, it is expected that legislation will prevent this severe a reduction in payment (see "Painful Changes in 2012 Medicare Fee Schedule").
Other codes with technical and professional components are the vestibular test code family (CPT 92540–92546, 92548) and the comprehensive auditory brainstem response testing code (92585). For more information, consult the Update to Audiology Policies [PDF] and Revisions and Re-Issuance of Audiology Policies [PDF].
Deb Abel of the American Academy of Audiology and Kim Cavitt of the Academy of Doctors of Audiology also contributed to this article.