Coding for Reimbursement Frequently Asked Questions: Audiology
Where can audiologists obtain a complete listing of codes, both procedure and diagnostic?
ASHA's "2014 Coding and Billing for Audiology and Speech-Language Pathology" provides CPT codes, ICD codes, and fee data in one reference. This guide is available through the ASHA online store or through ASHA's Product Sales at 1-888-498-6699. Ask for Item #0113382.
A list of CPT codes with descriptors and associated fees for speech-language pathology and audiology can also be found in the ASHA Medicare Fee Schedule or the Superbill for Audiology Practice [PDF]. Go to the American Medical Association's (AMA) website to order the official CPT Manual.
What is a "superbill?"
A superbill is a time efficient form to document services, fees, codes, and other information required by health plans. Models are available for download by selecting Superbill for Audiology Practice [PDF].
What is a CMS 1500 form?
Non-institutional providers and suppliers with less than 10 full-time employees can use the CMS 1500 form to bill Medicare Part B services in place of electronic billing. Some Medicaid and private health plans may also require you to file claims for reimbursement on the CMS 1500 form, but you should check with each payer. The Centers for Medicare and Medicaid Services (CMS) does not supply the form; providers should purchase claim forms through the US Government Printing Office, local printing companies in your area, and/or office supply stores. The only acceptable claim forms are those printed in Flint OCR Red, J6983 (or exact match) ink, and copies of the form cannot be used for submission of claims. A sample black and white form [PDF] is available on the CMS site, but cannot be used for submission of claims.
What are place of service codes and where can audiologists obtain a complete listing of them, with descriptions?
Place of service codes are used on claims to specify the entity where service(s) were rendered. Check with individual payers (e.g., Medicare, Medicaid, private health plans) for policies regarding these codes.
You may find a list of place of service codes, with descriptions, at the Centers for Medicare and Medicaid Services' (CMS) website. Private practices are often coded as an "office" location.
Can audiologists bill CPT 92543 for each caloric irrigation performed?
Yes. The CPT descriptor for this code states "per irrigation." One unit should be billed for each thermal irrigation, up to 4 units per day.
What are the infant hearing testing codes?
Medicaid and private payers may vary wideline in the codes they recommend for billing the infant hearing screening, if it is a separately payable benefit from the delivery charge. There are codes available that can be used to differentiate early hearing detection screening and evaluation to a payer.
If you are screening infants using equipment with an automated protocol, the options include:
92586, Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system, limited
92558, Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis
V5008, Hearing screening
If you are evaluating an infant for hearing loss, including professional interpretation and report, the appropriate codes included:
92585, Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system, comprehensive
92587, 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 report92588, Comprehensive or diagnostic evaluation (comparison of transient and distortion product otoacoustic emissions at multiple levels and frequencies)
92588, Distortion product evoked otoacoustic emissions, comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report
For more information on the appropriate use of these OAE codes, see CPT Coding for Otoacoustic Emissions: FAQs.
How do audiologists code "normal hearing" results when performing a hearing screening or an audiological evaluation?
It is important to check with the plan in question. Medicare's policy is that you should code for the sign(s) or symptom(s) that prompted the test to be ordered.
What code/s should I use for auditory processing (AP) evaluation and treatment?
An audiologist performing an AP evaluation can code in one of two ways:
- If the audiologist is performing more than one test, or a central auditory function battery, 92620 (Evaluation of central auditory function, with report; initial 60 minutes) with 92621 (for each additional 15 minutes) should be used.
- If the audiologist is performing only a single test, one of the following codes should be used, as appropriate:
The diagnostic codes used by audiologists for diagnosing central auditory processing disorders are in the 388.4 series (other abnormal auditory perception) or 794.15 (abnormal auditory function study - if electrophysiological tests are performed).
The diagnostic code used by SLPs for diagnosing auditory processing disorders is 315.32 (developmental mixed receptive-expressive language disorder, central auditory processing disorder).
- 92571 (filtered speech test);
- 92572 (staggered spondaic word test); and
- 92576 (synthetic sentence identification test).
Can procedure codes be billed by units of time?
Most audiology procedure codes do not have time units assigned to them. Therefore, if no time is noted, each code counts as one session. A complete list of the CPT codes for speech-language pathology and audiology services can also be found in the Medicare Fee Schedule or the Superbill for Audiology Practice [PDF]. For more information, see Timed & Untimed CPT Codes.
Can the services provided by a Clinical Fellow (CF) be submitted to a health plan for reimbursement?
There is no uniform standard for private payers, and Medicaid programs vary in provider enrollment and state licensure. Medicare's guidance includes 100% supervision by a qualified audiologist. A Doctor of Audiology (AuD) 4th-year student with a provisional license does not meet the definition of a qualified audiologist and therefore requires supervision, unless he or she als holds a master's or doctoral degree in audiology.
How do I establish fees for audiology services?
You may refer to the Medicare Fee Schedule for a general idea of what Medicare reimburses for specific procedures. It is important for you to know that Medicare rates reflect a budgetary constraint and may not reflect current market rates. You can also purchase historic fee data from medical coding publishers. ASHA's "Negotiating Health Care Contracts and Calculating Fees" (available through the ASHA online store, Item #0112450) also offers national charge data to help you evaluate your fees by comparing your charges to those of other practitioners nationwide.
Discussing fees with other local practices may be construed as price-fixing. Setting prices in collusion with colleagues is illegal.
What is the appropriate CPT code for Auditory Steady-State-Response System Testing (ASSR)?
It is appropriate to code ASSR using 92585 (Auditory evoked potentials for evoked response audiometry, and/or testing of the central nervous system; comprehensive.
What CPT code should I use for Vestibular Evoked Myogenic Potential (VEMP) testing?
There is no specific CPT code for VEMP testing. Audiologists should use 92700, Unlisted otorhinolaryngological service or procedure.