Coding for Reimbursement Frequently Asked Questions: Audiology
- Where can audiologists obtain a complete listing of codes, both procedure and diagnostic?
- What is a "superbill"?
- What is a CMS 1500 form?
- What are place of service codes and where can audiologists obtain a complete listing of them, with descriptions?
- What are the infant hearing testing codes?
- How do audiologists code "normal hearing" results when performing a hearing screening or an audiologic evaluation?
- What code/s should I use for auditory processing (AP) evaluation and treatment?
- Can procedure codes be billed by units of time?
- Can the services provided by a 4th year AuD student be submitted to a health plan for reimbursement?
- How do I establish fees for audiology services?
- What CPT code should I use for Vestibular Evoked Myogenic Potential (VEMP) testing?
Where can audiologists obtain a complete listing of codes, both procedure and diagnostic?
ASHA's Medicare Fee Schedule or superbill template for audiology services provide a list of Current Procedural Terminology (CPT) procedure codes with descriptors. Go to the American Medical Association's (AMA) website to order the official CPT Manual. ASHA also provides a curated list of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis codes related to hearing and vestibular disorders.
A superbill is a time efficient form to document services, fees, codes, and other information required by health plans. Download ASHA's customizable superbill template for your practice or facility.
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 form [PDF] is available on the CMS site, but cannot be used for submission of claims.
What are place of service codes and where can audiologists obtain a complete listing of them, with descriptions?
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 typically coded as an "office" location (POS 11).
What are the infant hearing testing codes?
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:
92558, Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis
92650, Auditory evoked potentials; screening of auditory potential with broadband stimuli, automated analysis
V5008, Hearing screening
If you are evaluating an infant for hearing loss, including professional interpretation and report, the appropriate codes included:
Auditory Evoked Potentials (AEP)
92651, Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report
92652, Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report
For more information the AEP codes, see Audiology CPT and HCPCS Code Changes for 2021.
Otoacaoustic Emissions (OAE)
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.
How do audiologists code "normal hearing" results when performing a hearing screening or an audiologic evaluation?
It is important to check with the plan in question. ICD-10 guidance 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.
What code/s should I use for auditory processing (AP) evaluation and treatment?
An audiologist performing an AP evaluation can code the procedure in one of two ways:
- If the audiologist is performing more than one test, or a central auditory function battery, 92620 (Evaluation of central auditory function, with report; initial 60 minutes) with 92621 (for each additional 15 minutes) should be used.
- If the audiologist is performing only a single test, one of the following codes should be used, as appropriate:
- 92571 (filtered speech test);
- 92572 (staggered spondaic word test); and
- 92576 (synthetic sentence identification test).
The diagnostic codes used by audiologists for diagnosing central auditory processing disorders is H93.25.(central auditory processing disorder).
Can procedure codes be billed by units of time?
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 template for audiology services. For more information, see The Right Time for Billing Codes.
Can the services provided by a 4th year AuD student be submitted to a health plan for reimbursement?
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 they also holds a master's or doctoral degree in audiology.
How do I establish fees for audiology services?
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.
What CPT code should I use for Vestibular Evoked Myogenic Potential (VEMP) testing?
Effective January 1, 2021, audiologists should use the following VEMP-specific CPT codes.
92517, Vestibular evoked myogenic potential testing, with interpretation and report; cervical (cVEMP)
92518, Vestibular evoked myogenic potential testing, with interpretation and report; ocular (oVEMP)
92519, Vestibular evoked myogenic potential testing, with interpretation and report; cervical (cVEMP) and ocular (oVEMP)
For more information, see Audiology CPT and HCPCS Code Changes for 2021.
