If you're confused about Medicare reimbursement for audiology services, you are not alone. Audiologists struggle with a host of Medicare issues—for example, what services are covered under what conditions, the appropriate billing codes for procedures and informing beneficiaries of coverage.
To help clarify these and other issues, ASHA leaders and staff meet monthly with representatives from nine other audiology organizations to discuss Medicare reimbursement and coding issues. The group has recently developed guidance on several topics: use of the Advanced Beneficiary Notice of Noncoverage, vestibular evoked myogenic potential testing, and codes for hearing aids that use contralateral routing of signals.
Advance Beneficiary Notice of Noncoverage
Providers use the ABN to notify Medicare beneficiaries that the service, product or treatment they receive will not (or may not) be covered by Medicare and that the beneficiary must pay for it. Medicare defines two different ABN situations—mandatory and voluntary notification.
Audiologists must use an ABN (mandatory notification) if the service to be provided may not meet the definition of medical necessity—for instance, if testing occurs more frequently than the norm or if the beneficiary's Medicare contractor excludes the service in its local coverage determination.
If the service is never covered under Medicare—for example, a hearing aid evaluation or canalith repositioning—the audiologist may provide an ABN (voluntary notification).
For more information and instructions on using the ABN, visit our FAQs page.
Vestibular evoked myogenic potential testing
VEMP testing is becoming a standard measure in vestibular evaluations, and audiologists need to know how to bill the procedure. There is no specific code to describe this testing. The American Medical Association, which owns the Current Procedural Terminology codes and definitions, published guidance in the March 2011 CPT Assistant stating that audiologists should use CPT 92700 (unlisted otorhinolaryngological service or procedure) to report VEMP testing.
Contralateral routing of signal hearing aids
Hearing aids designated as contralateral routing of signal or as bilateral contralateral routing of signal have specific codes under the Healthcare Common Procedure Coding System that include both the transmitter and receiver or the receiver/hearing aid. Typically, no other hearing aid device codes should be billed in addition to the CROS/BiCROS codes, unless the third-party payer has instructed otherwise:
- V5170: Hearing aid, CROS, in the ear.
- V5180: Hearing aid, CROS, behind the ear.
- V5190: Hearing aid, CROS, glasses.
- V5210: Hearing aid, BiCROS, in the ear.
- V5220: Hearing aid, BiCROS, behind the ear.
- V5230: Hearing aid, BiCROS, glasses.
For more information on CROS/BiCROS, visit our coding page.
Rotational chair evaluations
ASHA has received a number of member questions about coding for rotational chair evaluations. The use of CPT 92546, sinusoidal vertical axis rotational testing, is the appropriate code to use when a computerized rotational chair and electrodes are used in the evaluation. The September 2004 CPT Assistant clarifies that 92546 designates an evaluation using a computer-controlled chair with the patient's head bent forward 30 degrees, and electronystagmography electrodes are placed to measure nystagmus while the chair is rotated with the patient's eyes closed.
If the evaluation is not performed in a rotational chair, the correct coding becomes less clear. Different Medicare contractors offer conflicting determination documents regarding the use of 92546: Some require the serial number of the chair and others indicate that 92546 may be used for active-head rotational testing. Audiologists should contact their local contractors for information on their requirements and definitions.