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

Medicare Audiology Billing Services

Clarifying Medicare Audiology Billing Services: Audiology and OTO-Techs

Recently, the Academy has received numerous questions from members on Medicare audiology billing and what services audiology/ otolaryngology-technicians (oto-techs) can bill. In response, resources on the Academy’s website have been developed to help to clarify this issue. (http://www.entnet.org/Practice/Medicareupdates.cfm#CP_JUMP_149730). A frequently asked question and answer is provided below, followed by a summary of information provided on our website.

This is meant to be a guide to assist with questions and not a definitive source. For a definitive list of what procedures audiology/ oto-tech’s can provide and bill, contact your Medicare Administrative Contractor because Medicare allows them to determine what services oto-techs can perform and the qualifications needed, based on state and/or local law. 

Q: What Services Can Oto-Techs Provide and Bill?

Answer: A physician orders a comprehensive audiometry threshold evaluation and speech recognition test (CPT 92557), but wonders if their certified audiology technician or oto-tech can perform and bill for this? In most states, the answer is no, they cannot. According to Medicare, audiology/oto-techs cannot bill Medicare for 92557 because there is no separate professional component (-26)/ technical component (TC) breakout where the technician would be able to bill for the TC. However, qualified professionals that have their own Medicare NPI, such as an Audiologist, may bill for this.

In June 2010, CMS released MedLearn Matters 6447, URL http://www.cms.gov/MLNMattersArticles/downloads/MM6447.pdf, which clarified the Medicare policy on billing for audiology services. CMS indicated that qualified technicians, including those trained in the Academy’s oto-tech program, can only perform diagnostic audiology tests (under direct physician supervision) that have a technical and professional component. In such cases, the technicians can only perform the technical component of the test. This revised policy took effect September 30, 2010. 

Tests that have a split professional and technical component (TC/ -26) most likely do not likely require an audiologist. The full list of Audiology codes can be found here, 

http://www.cms.gov/Medicare/Billing/TherapyServices/Downloads/Audiology_Codes.pdf. 

For codes that do have a split, an oto-tech (or other practitioners that furnishes the technical component) may perform the technical component of the service under direct physician supervision (note that for CPT codes with a split, the physician, non-physician practitioner or audiologist must perform the professional component of the tests). However, as mentioned previously, be sure to check with your local Medicare contractor for guidelines. 

The medical record must contain the name and professional identity of the technician who actually performed the service. The physician must order the audiological diagnostic testing specifically, listing each test individually. Again, check with your local Medicare contractor for guidelines.

Audiology

Providers must be enrolled as a Colorado Medical Assistance Program provider in order to: 

Treat a Colorado Medical Assistance Program member 

Submit claims for payment to the Colorado Medical Assistance Program

Billing Information

National Provider Identifier (NPI)

The Health Insurance Portability and Accountability Act (HIPAA) requires that covered entities (i.e., health plans, health care clearinghouses, and those health care providers who transmit any health information electronically in connection with a transaction for which the Secretary of Health and Human Services has adopted a standard) use NPIs in standard transactions.

Paper Claims 

Electronic claims format shall be required unless hard copy claims submittals are specifically prior authorized by the Department of Health Care Policy and Financing (the Department). Requests for paper claim submission may be sent to the fiscal agent, Xerox State Healthcare (Xerox), P.O. Box 30, Denver, CO 80201-0090. 

The following claims can be submitted on paper and processed for payment:

•  Claims from providers who consistently submit 5 claims or fewer per month (requires prior approval) 
• Claims that, by policy, require attachments 
• Reconsideration claims Paper claims do not require an NPI, but do require the Colorado Medical Assistance Program provider number. 

In addition, the UB-04 Certification document must be completed and attached to all claims submitted on the paper UB-04. Electronically mandated claims submitted on paper are processed, denied, and marked with the message “Electronic Filing Required”.

Electronic Claims

Instructions for completing and submitting electronic claims are available through the following: 

•  X12N Technical Report 3 (TR3) for the 837P, 837I, or 837D
•  Companion Guides for the 837P, 837I, or 837D in the Provider Services  section of the Department’s website.
• Web Portal User Guide (via within the Web Portal)