CPT code

What CPT codes should I use for behavioral pediatric audiologic evaluations using visual reinforcement audiometry (VRA) and conditioning play audiometry (CPA) test techniques?

92579 (VRA) and 92582 (CPA) are codes that describe specific, independent pediatric test procedures. These codes are currently valued as stand-alone procedure codes and are not "add-on" or modifier codes. Generally, these codes should not be used in addition to pure tone audiometry, air only (92552) or air and bone donduction audiometry (92553) to indicate a method of testing.

Is speech audiometry included in the CPA and VRA codes?

92579 (VRA) and 92582 (CPA) are differentiated by the method of response reinforcement used and the types of stimuli that are considered part of the procedure. These codes are historical codes and currently do not have detailed code descriptions. Payers have relied on traditional practice standards that were available at the time the codes were last valued. Historically, descriptions of VRA test procedures included both speech and tonal stimuli as part of the test protocol. In contrast, CPA test protocols included tonal stimuli but did not include speech stimuli.

If CPA (92582) testing is completed and speech measures are performed as part of the evaluation, then a code that best describes the speech measure, such as speech threshold audiometry (92555), select picture audiometry (92583), or speech audiometry threshold with speech recognition (92556), can also be reported.

What if I test individual ears using visual reinforcement audiometry techniques?

In this case, it would still be appropriate to report the VRA code (92579) as it best reflects the technique and equipment that has been utilized to conduct the assessment. Since the VRA and CPA (92582) codes cannot be billed in addition to pure-tone air or bone conduction threshold codes, you should choose the code that best aligns with your clinical assessment.

What if I attempt audiologic testing on a child but obtain limited results or no interpretable results?

The issue of limited or no audiologic test results is a complicated one; the codes that you select should accurately reflect the procedures, techniques, and effort that were used, not specifically the number of responses that were obtained.

A child may require frequent reconditioning or test reinstruction, yet limited audiologic information is obtained. In this case the audiologist has used considerable effort, various procedures, and/or different reinforcement techniques to obtain those limited results. This would not be considered a reduced service.

Documentation of the test session should include the efforts made to obtain test results; some clinicians may document a time notation in the patient’s medical record as an estimate of the time and effort involved when limited audiologic information is obtained.

There may be a number of reasons why no audiologic results are obtained. However, in a situation where a child is completely uncooperative with any test procedure, the audiologist has a choice of cancelling the appointment altogether or using a reduced service modifier (-52) to indicate that the entire protocol associated with the diagnostic procedure was not completed.

What CPT codes should I use when testing middle ear function?

New CPT codes were created in 2010, at the request of the Centers for Medicare and Medicaid Services (CMS), to report middle ear function tests that were frequently performed together on the same date of service. Four distinct codes are now available:

• 92567 Tympanometry (impedance testing)
• 92568 Acoustic reflex testing, threshold
• 92550 Tympanometry and reflex threshold measurements
• 92570 Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing

The individual code for acoustic reflex decay testing (92569) was deleted at the time of the 2010 code changes.

If acoustic reflex threshold testing or acoustic reflex threshold testing and acoustic reflex decay testing are performed on the same date of service as tympanometry, you must report the bundled code that describes what has been performed. You may not report tympanometry (92567) and acoustic reflex threshold testing (92568) separately on the same date of service.

If I perform a 1000 Hz ipsilateral acoustic reflex screening along with tympanometry, can I use CPT code 92550 (Tympanometry and reflex threshold measurement)?

CPT has defined acoustic reflex threshold testing (92568 and 92550) as including both ipsilateral and contralateral acoustic reflex threshold measurements. There is not a CPT code available for acoustic reflex screening. Only the tympanometry code (92567) would be allowed in this instance.

Are there CPT codes for the new wideband reflectance and multi-frequency tympanometry tests?

New methods of assessing middle ear function are now available in clinical test equipment. Although these advanced middle ear test methods are becoming accepted as part of a clinical test battery, there are no current CPT codes for these tests.

The tympanometry-only code (92567) should be used if wideband reflectance or multi-frequency tympanometry tests are completed. The code is a session-based code, meaning that 92567 can only be billed one time per day, even if standard and multi-frequency tympanometry as well as wideband reflectance testing are all completed on the same day.

An extended service modifier (-22) could be considered when multi-frequency tympanometry and wideband reflectance testing are completed on the same day. Detailed documentation of the justification for the extended service should be included in the patient’s medical record.

What CPT codes should I use when I test otoacoustic emissions (OAE)?

There are three (3) OAE codes that clearly describe the differences between screening OAE and limited versus comprehensive OAE evaluation. The OAE codes assume that testing is completed in both ears.

• 92558 Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis
• 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

The OAE screening code (92558) should be billed when only an overall Pass/Fail result is obtained and no other interpretation is performed or reported.

The OAE limited evaluation code (92587) should be used when the purpose of the test is to evaluate hearing status. 92587 specifies that three (3) to six (6) Distortion Product (DPOAE) frequencies should be evaluated per ear. Transient Evoked OAE testing (TEOAE) is included in this code.

The OAE comprehensive evaluation code (92588) should be used when the purpose of the test is to evaluate outer hair cell function or to perform cochlear mapping for purposes such as ototoxic monitoring or tinnitus evaluation. 92588 specifies that 12 or more distortion product OAE frequencies should be evaluated per ear.

Medicare Billing : 837P and Form CMS-1500

What are the 837P and Form CMS-1500? 

The 837P (Professional) is the standard format used by health care professionals and suppliers to transmit health care claims electronically. The Form CMS-1500 is the standard paper claim form to bill Medicare Fee-For-Service (FFS) Contractors when a paper claim is allowed. In addition to billing Medicare, the 837P and Form CMS-1500 may be suitable for billing various government and some private insurers.

Data elements in the Centers for Medicare & Medicaid Services (CMS) uniform electronic billing specifications are consistent with the hard copy data set to the extent that one processing system can handle both. CMS designates the 1500 Health Insurance Claim Form as the CMS-1500 (08/05) and the form is referred to throughout this fact sheet as the CMS-1500.

When Does Medicare Accept a Hard Copy Claim Form? 

Initial claims for payment under Medicare must be submitted electronically unless a health care professional or supplier qualifies for a waiver or exception from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims. 

Before submitting a hard copy claim, health care professionals and suppliers should self-assess to determine if they meet one or more of the ASCA exceptions. For example, health care professionals and suppliers that have fewer than 10 Full-Time Equivalent (FTE) employees and bill a Medicare FFS Contractor are considered to be small and might therefore qualify to be exempt from Medicare electronic billing requirements. If a health care professional or supplier meets an exception, there is no need to submit a waiver request. 

There are other situations when the ASCA electronic billing requirement could be waived for some or all claims, such as if disability of all members of a health care professional’s or supplier’s staff prevents use of a computer for electronic submission of claims. Health care professionals and suppliers must obtain Medicare pre-approval to submit paper claims in these situations by submitting a waiver request to their Medicare FFS Contractor. 

Timely Filing 

The timely filing period for both paper and electronic Medicare claims is 12 months, or one calendar year, after the date of service. 

Claims are denied if they arrive after the deadline date. When a claim is denied for having been filed after the timely filing period, such a denial does not constitute an initial determination. As such, the determination that a claim was not filed timely is not subject to appeal. 

Medicare uses the line item ‘From’ date to determine the date of service for claims filing timeliness for claims submitted by health care professionals and suppliers that include span dates of service. (This includes DME supplies and rental items.) If a line item ‘From’ date is not timely but the ‘To’ date is timely, contractors must split the line item and deny the untimely services as not timely filed.