ASHA's annual "Coding and Billing for Audiology and Speech-Language Pathology" product 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.
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 [DOC]. Go to the American Medical Association's (AMA) website to order the official CPT Manual.
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 [DOC].
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 U.S. 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.
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.
Medicaid and private payers may vary widely 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 report
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.
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. See also: Coding Normal Results Frequently Asked Questions.
An audiologist performing an AP evaluation can code the procedure in one of two ways:
The diagnostic codes used by audiologists for diagnosing central auditory processing disorders is H93.25.(central auditory processing disorder).
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 audiology services can also be found in the Medicare Fee Schedule or the Superbill for Audiology Practice [DOC]. For more information, see Timed & Untimed CPT Codes.
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 also holds a master's or doctoral degree in audiology.
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.
Discussing fees with other local practices may be construed as price-fixing. Setting prices in collusion with colleagues is illegal.
It is appropriate to code ASSR using 92585 (Auditory evoked potentials for evoked response audiometry, and/or testing of the central nervous system; comprehensive.
There is no specific CPT code for VEMP testing. Audiologists should use 92700, Unlisted otorhinolaryngologic service or procedure.