Audiology CPT Code Changes for 2020

The following revisions, additions, and deletions to Current Procedural Terminology (CPT ® American Medical Association) codes related to hearing and vestibular services were effective January 1, 2020. There were no major changes to Health Care Common Procedure Coding System (HCPCS) device codes for 2020. Audiologists can contact ASHA's health care policy team at reimbursement@asha.org for questions.

For current updates, see new and revised audiology CPT codes for 2022.

New and Revised CPT Codes

The following new and revised CPT codes were effective January 1, 2020.

Computerized Dynamic Posturography

92548 Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report;

92549 with motor control test (MCT) and adaptation test (ADT)

(Do not report 92548, 92549 in conjunction with 92270)

ASHA NOTES

See also: Prepare for New and Revised CPT Codes Set to Debut in 2020 and 2020 Medicare Fee Schedule for Audiologists [PDF]
92548 is revised to clearly describe the required sensory organization testing, which must include all six conditions, as outlined in the code descriptor.
92549 is a new code to describe the more extensive CDP testing protocol (SOT, MCT, and ADT). 92549 may not be billed in conjunction with 92548 because it already represents the entire battery of tests.
Remember to check each payer for policies related to same-day billing with other codes (National Correct Coding Initiative or CCI edits).

Pre- and Post-Implant Evaluation of Auditory Function

92626 Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); first hour

92627 each additional 15 minutes (list separately in addition to code for primary procedure)

(Use 92627 in conjunction with 92626)

(When reporting 92626, 92627, use the face-to-face time with the patient or family)

(Do not report 92626, 92627 in conjunction with 92590, 92591, 92592, 92593, 92594, 92595 for hearing aid evaluation, fitting, follow-up, or selection)

ASHA NOTES

See also: Prepare for New and Revised CPT Codes Set to Debut in 2020 and 2020 Medicare Fee Schedule for Audiologists [PDF]
CPT codes 92626 and 92627 are revised and should be use to report an evaluation to determine candidacy for a surgically implanted hearing device (for example, a cochlear implant or an osseointegrated implant) or for post-surgical evaluation of performance.
These codes may no longer be used for activities unrelated to an implant, such as an auditory function evaluation before or after a patient receives hearing aids or other assistive technology.
These codes may not be billed with CPT codes 92590-92595 for hearing aid services provided to a single patient on the same day. However, the same restrictions aren’t in place for corresponding V-codes or if the services are provided by different clinicians on the same day.
92626 (base code) and 92627 (add-on code) continue to be time-based codes. 92626 represents the first hour of evaluation. Report 92627 in conjunction with 92626 when the evaluation extends beyond the first hour. Learn more about correct billing of timed codes.
Remember to check each payer for policies related to
- same-day billing with other codes (National Correct Coding Initiative or CCI edits) and
- how many units can billed on the same day (medically unlikely edits or MUEs).

Nonphysician Online Digital Evaluation and Management (E/M) Service

98970 Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes

98971 11–20 minutes

98972 21 or more minutes

(Report 98970, 98971, 98972 once per 7-day period)

(Do not report online digital E/M services for cumulative visit time less than 5 minutes)

(Do not count 98970, 98971, 98972 time otherwise reported with other services)

ASHA NOTES

It is important to check with payers regarding use of these new codes. Many payers do not cover E/M services provided by qualified nonphysician health care professionals, such as audiologists. Learn more about billing E/M codes.
In the 2020 Medicare Physician Fee Schedule [PDF] final rule, Medicare finalized similar G-codes for nonphysician practitioners (e.g., nurse practitioner, physician assistant) and clarified that these services are not covered by Medicare when provided by audiologists and SLPs.
To correctly report, an online digital E/M service must be
- initiated by an established patient,
- unrelated to a previous evaluation or treatment session provided within the last seven days,
- conducted through a HIPAA-compliant platform, and
- medically necessary (requires clinical decision making and is not for administrative or scheduling purposes).
These services do not represent real-time interactions and do not replace evaluation or treatment services described by existing CPT codes.
Documentation of clinical decision making and storage of the exchange are required.