Oto-tech program

Q: What's happens to the oto-techs who are well-trained through our Academy's oto-tech program? 

Answer: Oto-techs can still perform the technical component of diagnostic audiology tests that have a professional and technical component. The physician must detail the specific tests the technician must perform, and provide direct supervision. The services can be billed under the name and NPI number of the physician. Contact your local Medicare contractor’s Medical Director to determine the specific diagnostic tests that technicians can perform and for which you will be reimbursed.

The Academy realizes this is a complex issue and other questions may arise, including those involving services performed by an Audiologist. The Academy has several resources available for members to help them navigate Medicare’s audiology billing requirements, including a newly revised Audiology FAQ available on our website at: http://www.entnet.org/Practice/Medicareupdates.cfm#CP_JUMP_149730.

The Academy also provides a coding hotline to members for specific questions about coding which can be reached Monday through Friday 7 am- 4 pm MST at 800-584-7773. Additional questions can be submitted to the Health Policy team at healthpolicy@entnet.org. 

CPT Code - 92540

Description - ENG Testing

Split PC/TC? - Yes 

CPT Code - 92541

Description - Spontaneous Nystagmus Test, w/Gaze & Fixation Nyst..

Split PC/TC? - Yes 

CPT Code - 92542

Description - Positional Nystagmus Test, Minimum, 4 Positions, w… 

Split PC/TC? - Yes 

CPT Code - 92543

Description - Caloric Testing

Split PC/TC? - Yes 

CPT Code - 92544

Description - Optokinetic Nystagmus Test, Bidirectional, Foveal…

Split PC/TC? - Yes 

CPT Code - 92545

Description - Oscillating Tracking Test, w/Recording

Split PC/TC? - Yes 

CPT Code - 92546

Description - Sinusoidal Vertical Axis Rotational Testing

Split PC/TC? - Yes 

CPT Code - 92547

Description - Use of vertical electrodes

Split PC/TC? - No

CPT Code - 92548

Description - Computerized Dynamic Posturography

Split PC/TC? - Yes 

CPT Code - 92550

Description - Tympanometry and Reflex Threshold

Split PC/TC? - No

CPT Code - 92552

Description - Pure Tone Audiometry (Threshold); Air Only

Split PC/TC? - No

Late Bill Override Date (LBOD) - Continued

Billing Instruction Detail - Retroactive Member Eligibility

Instructions -  The claim is for services provided to an individual whose Colorado Medical Assistance Program eligibility was backdated or made retroactive.

File the claim within 120 days of the date that the individual’s eligibility information appeared on state eligibility files. Obtain and maintain a letter or form from the county departments of social services that:

•  Identifies the patient by name 
•  States that eligibility was backdated or retroactive 
•  Identifies the date that eligibility was added to the state eligibility system.  

LBOD = the date shown on the county letter that eligibility was added to or first appeared on the state eligibility system.

Billing Instruction Detail - Delayed Notification of Eligibility

Instructions 

The provider was unable to determine that the patient had Colorado Medical Assistance Program coverage until after the timely filing period expired.

 File the claim within 60 days of the date of notification that the individual had Colorado Medical Assistance Program coverage.

Billing Instruction Detail - Delayed Notification of Eligibility 

Instructions 

• Retain correspondence, phone logs, or a signed Delayed Eligibility Certification form  that identifies the member, indicates the effort made to identify eligibility, and shows the date of eligibility notification.
• Claims must be filed within 365 days of the date of service. No exceptions are allowed.
• This extension is available only if the provider had no way of knowing that the individual had Colorado Medical Assistance Program coverage. 
• Providers who render services in a hospital or nursing facility are expected to get benefit coverage information from the institution. 
• The extension does not give additional time to obtain Colorado Medical Assistance Program billing information. 
• If the provider has previously submitted claims for the member, it is improper to claim that eligibility notification was delayed.

 LBOD = the date the provider was advised the individual had Colorado Medical Assistance Program benefits.

Billing Instruction Detail - Electronic Medicare Crossover Claims 

Instructions 

An electronic claim is being submitted for Medicare crossover benefits within 120 days of the date of Medicare processing/ payment. (Note: On the paper claim form (only), the Medicare SPR/ERA date field documents crossover timely filing and completion of the LBOD is not required.) 

File the claim within 120 days of the Medicare processing/ payment date shown on the SPR/ERA. Maintain the original SPR/ERA on file. 

LBOD = the Medicare processing date shown on the SPR/ERA.

Billing Instruction Detail - Medicare Denied Services 

Instructions 

The claim is for Medicare denied services (Medicare non-benefit services, benefits exhausted services, or the member does not have Medicare coverage) being submitted within 60 days of the date of Medicare processing/denial. 

Note: This becomes a regular Colorado Medical Assistance Program claim, not a Medicare crossover claim. 

File the claim within 60 days of the Medicare processing date shown on the SPR/ERA. Maintain the original SPR/ERA on file.

 LBOD = the Medicare processing date shown on the SPR/ERA.

Billing Instruction Detail - Commercial Insurance Processing  

Instructions 

The claim has been paid or denied by commercial insurance. 

File the claim within 60 days of the insurance payment or denial. Retain the commercial insurance payment or denial notice that identifies the patient, rendered services, and shows the payment or denial date.

Claims must be filed within 365 days of the date of service. No exceptions are allowed. If the claim is nearing the 365-day limit and the commercial insurance company has not completed processing, file the claim, receive a denial or rejection, and continue filing in compliance with the 60-day rule until insurance processing information is available. 

LBOD = the date commercial insurance paid or denied.

Billing Instruction Detail - Correspondence LBOD Authorization  

Instructions 

The claim is being submitted in accordance with instructions (authorization) from the Colorado Medical Assistance Program for a 60 day filing extension for a specific member, claim, services, or circumstances. 

File the claim within 60 days of the date on the authorization letter. Retain the authorization letter. LBOD = the date on the authorization letter.

Billing Instruction Detail - Member Changes Providers during Obstetrical Care  

Instructions 

The claim is for obstetrical care where the patient transferred to another provider for continuation of OB care. The prenatal visits must be billed using individual visit codes but the service dates are outside the initial timely filing period. 

File the claim within 60 days of the last OB visit. Maintain information in the medical record showing the date of the last prenatal visit and a notation that the patient transferred to another provider for continuation of OB care.

 LBOD = the last date of OB care by the billing provider

Late Bill Override Date (LBOD)

The Late Bill Override Date (LBOD) allows providers to document compliance with timely filing requirements when the initial timely filing period has expired. Colorado Medical Assistance Program providers have 120 days from the date of service to submit their claim.

Making false statements about timely filing compliance is a misrepresentation and falsification that, upon conviction, makes the individual who prepares the claim and the enrolled provider subject to a fine and imprisonment under state and/or federal law. 

Billing Instruction Detail  -  LBOD Completion Requirements 

Instructions 

•  Electronic claim formats provide specific fields for documenting the LBOD. 
• Supporting documentation must be kept on file for 6 years. 
• For paper claims, follow the instructions appropriate for the claim form you are using. 

1. UB-04: Occurrence code 53 and the date are required in FL 31-34. 
2. CMS-1500: Indicate “LBOD” and the date in box 19 – Remarks.

Billing Instruction Detail  -  Adjusting Paid Claims

Instructions 

If the initial timely filing period has expired and a previously submitted claim that was filed within the original Colorado Medical Assistance Program timely filing period or the allowed 60 day follow-up period was paid and now needs to be adjusted, resulting in additional payment to the provider

Adjust the claim within 60 days of the claim payment. Retain all documents that prove compliance with timely filing requirements. 

Note: There is no time limit for providers to adjust paid claims that would result in repayment to the Colorado Medical Assistance Program. 

LBOD = the run date of the Colorado Medical Assistance Program Provider Claim Report showing the payment.

Billing Instruction Detail  -  Denied Paper Claims

 Instructions 

If the initial timely filing period has expired and a previously submitted paper claim that was filed within the original Colorado Medical Assistance Program timely filing period or the allowed 60 day follow-up period was denied. 

Correct the claim errors and refile within 60 days of the claim denial or rejection. Retain all documents that prove compliance with timely filing requirements. 

LBOD = the run date of the Colorado Medical Assistance Program Provider Claim Report showing the denial.

Billing Instruction Detail  -  Returned Paper Claims

 Instructions 

An electronic claim that was previously entered within the original Colorado Medical Assistance Program timely filing period or the allowed 60 day follow-up period was rejected and information needed to submit the claim was not available to refile at the time of the rejection.

Correct claim errors and refile within 60 days of the rejection. Maintain a printed copy of the rejection notice that identifies the claim and date of rejection. 

LBOD = the date shown on the claim rejection report.

Billing Instruction Detail  -  Denied/Rejected Due to Member Eligibility

 Instructions 

An electronic eligibility verification response processed during the original Colorado Medical Assistance Program timely filing period states that the individual was not eligible but you were subsequently able to verify eligibility. Read also instructions for retroactive eligibility. 

File the claim within 60 days of the date of the rejected eligibility verification response. Retain a printed copy of the rejection notice that identifies the member and date of eligibility rejection. 

LBOD = the date shown on the eligibility rejection report.

Procedure/HCPCS Codes Overview

The codes used for submitting claims for services provided to Colorado Medical Assistance Program members represent services that are approved by the Centers for Medicare and Medicaid Services (CMS) and services that may be provided by an enrolled Colorado Medical Assistance Program provider.

The Healthcare Common Procedural Coding System (HCPCS) is divided into two principal subsystems, referred to as level I and level II of the HCPCS. Level I of the HCPCS is comprised of Current Procedural Terminology (CPT), a numeric coding system maintained by the American Medical Association (AMA). The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Level II codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits.

HIPAA requires providers to comply with the coding guidelines of the AMA CPT Procedure Codes and the International Classification of Disease, Clinical Modification Diagnosis Codes. If there is no time designated in the official descriptor, the code represents one unit or session. Providers should regularly consult monthly bulletins in the Provider Services Bulletins section. To receive electronic provider bulletin notifications, an email address can be entered into the Web Portal in the (MMIS) Provider Data Maintenance area or by filling out a publication preference form. Bulletins include updates on approved procedure codes as well as the maximum allowable units billed per procedure.  

Late Bill Override Date

For electronic claims, a delay reason code must be selected and a date must be noted in the “Claim Notes/LBOD” field. 

Valid Delay Reason Codes

 1 Proof of Eligibility Unknown or Unavailable 

 3 Authorization Delays 

 7 Third Party Processing Delay 

 8 Delay in Eligibility Determination

 9 Original Claim Rejected or Denied Due to a Reason Unrelated to the Billing Limitation Rules 

11 Other

Procedure Code Table - Continuation

CPT or HCPCS Procedure Code : T1024

Short Description: Team evaluation & management

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : T1025
Short Description: Ped compr care pkg, per diem 

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : V5010
Short Description: Hearing aid evaluation test 

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5011
Short Description: Fitting/orientation/checking of hear aid 

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5014
Short Description: Hearing aid repair/modifying

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5060
Short Description: Behind ear hearing aid

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5090
Short Description: Dispensing fee

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5095
Short Description:Implant mid ear hearing pros

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : V5140
Short Description:Behind ear binaur hearing ai

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5244
Short Description:Hearing aid, prog, mon, cic

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5245
Short Description:Hearing aid, prog, mon, itc

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5246
Short Description:Hearing aid, prog, mon, itc

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5247
Short Description:Hearing aid, prog, mon, bte

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5250
Short Description:Hearing aid, prog, bin, cic

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5251
Short Description:Hearing aid, prog, bin, itc

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5252
Short Description:Hearing aid, prog, bin, ite

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5253
Short Description:Hearing aid, prog, bin, bte

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5254
Short Description:Hearing id, digit, mon, cic

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5255
Short Description:Hearing aid, digit, mon, itc

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5256
Short Description:Hearing aid, digit, mon, ite

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5257
Short Description:Hearing aid, digit, mon, bte

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5258
Short Description:Hearing aid, digit, bin, cic

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5259
Short Description:Hearing aid, digit, bin, itc

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5260
Short Description:Hearing aid, digit, bin, ite

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5261
Short Description:Hearing aid, digit, bin, bte

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5262
Short Description:Hearing aid, disp, monaural

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : V5263
Short Description:Hearing aid, disp, binaural

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : V5264
Short Description:Ear mold/insert

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : V5265
Short Description:Ear mold/insert, disposable

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : V5266
Short Description:Battery for hearing device

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5267
Short Description:Hearing aid supply/accessory

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5275
Short Description:Ear impression

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5299
Short Description:Hearing service

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : V5336
Short Description:Repair/mod augmentative com sys/or devic

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : V5362
Short Description:Speech screening

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : V5363
Short Description:Language screening

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : V5364
Short Description:Dysphagia screening

Covered Benefit :No

Prior Authorization Needed: -

Procedure Code Table - continued

CPT or HCPCS Procedure Code : 99215

Short Description: Office/outpatient visit est

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 99241

Short Description: Office consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99242

Short Description: Office consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99243

Short Description: Office consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99244

Short Description: Office consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99245

Short Description: Office consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99251

Short Description: Inpatient consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99252

Short Description: Inpatient consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99253

Short Description: Inpatient consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99254

Short Description: Inpatient consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99255

Short Description: Inpatient consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : L7510

Short Description: Prosthetic device repair rep

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8515
Short Description: Gel cap app device for trach

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8615
Short Description: Headpiece for cochlear implant

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8616
Short Description: Microphone for cochlear implant

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8617
Short Description: Transmit coil cochlear implant

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8618
Short Description: Transmit cable cochlear impl

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8619
Short Description: Coch imp ext proc/contr rplc

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8621
Short Description: Zinc air battery cochlear impl

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8622
Short Description: Alkaline battery cochlear imp

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8623
Short Description: Lith ion batt CID, non-ear lvl

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8624
Short Description: Lith ion batt CID, ear level

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8691
Short Description: Auditory osseointegrated device, external sound processor, replacement

Covered Benefit :Yes

Prior Authorization Needed: Yes

CPT or HCPCS Procedure Code : L8692
Short Description: Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment

Covered Benefit :Yes

Prior Authorization Needed: Yes

CPT or HCPCS Procedure Code : S0618
Short Description: Audiometry for hearing aid evaluation to determine the level and degree of hearing loss

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : S9152
Short Description: Speech therapy, re-eval

Covered Benefit :No

Prior Authorization Needed: -