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Auditory Function Evaluation and Computerized Dynamic Posturography: Codes and Payment Rates for 12020 By Erin L. Miller and Patricia Gaffney

I n late 2018, the American Academy of Audiology, in collaboration with the American-Speech-Language­

Hearing Association (ASHA), the American Academy of Neurology (AAN), and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) surveyed the auditory function evaluation and computerized dynamic posturog­raphy codes at the request of the Centers for Medicare and Medicaid Services (CMS).

A description of the new and revised codes follows:

■ CPT Code 92626: Evaluation of auditory function for candidacy or post-operative status of surgi­cally implanted devices or other auditory treatment interventions; first hour.

■ CPT Code 92627: Each additional 15 minutes (list separately in addition to code for primary procedure).

■ CPT Code 92548: Computerized dynamic posturography sensory organization test (CDP-SOT), six conditions (i.e., eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual

AUDIOLOGY TODAY Nov/Dec 2019

sway) including interpretation and report.

■ CPT Code 92549: Computerized dynamic posturography sensory organization test (CDP-SOT), six conditions (i.e., eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway) includ­ing interpretation and report; with motor control test (MCT) and adaptation test (ADT).

In 2013, CMS identified CPT code 92626 for review due to a rapid increase in use. A coding brief was published in the CPT Assistant in July 2014 to clarify CPT code 92626 was to be used to report the eval­uation of the auditory function of a patient either prior to or after receiving hearing devices, auditory osseo-integrated implants, mid­dle-ear implants, and/or cochlear implant(s), or to monitor the progress of therapeutic intervention.

It was further clarified that the code was not intended for use for hearing aid examination, selec-tion fitting and/or checking (codes 92590-92595, V5010-V5011), or diag­nostic cochlear implant analysis and programming or subsequent repro­gramming (codes 92601-92604).

CMS requested that the audiology associations review CPT code 92626 three years after the 2014 publication of the CPT Assistant coding brief as use continued to increase despite education efforts. At the October 2017 Relative Value Update Committee (RUC) meeting, the Academy and ASHA presented an action plan to bring this code back to CPT for revi­sion and to clarify its intended use. The CPT Editorial Panel approved the code revisions in September 2018.

CPT code 92548 (Computerized Dynamic Posturography) was identified by the American Medical Association (AMA) through their RUC screening process, which identified this as a code that had a different specialty as primary user from the original surveying spe­cialty. As part of the process, the Academy, along with ASHA, AAN, and AAO-HNS were required to revise the current CPT code 92548. Additionally, representatives from the associations recommended the creation of a new CPT code 92549 to describe an expansion of work and equipment necessary to provide this new service.

Following CPT code revisions, or for newly established CPT codes, the professional associations must sur­vey their memberships to assess and

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revise the "professional work" value for each procedure . Professional work value includes factors such as mental effort and judgment, technical skill, and psychological stress .

This part of the valuation process was established by the American Medical Association (AMA) RUC and was completed by the relevant interested medical special­ties . After reviewing the collected survey data, representatives from the specialty associations prepared a strong recommen­dation, based on the results, to use in their presentation to the RUC.

Presentations were made for the posturography codes and to the Health Care Professionals Advisory Committee (HCPAC) for the auditory function codes . The RUC and HCPAC agreed with the proposed values for all four revised and/or new codes and made a recommendation to CMS to accept these values .

For calendar year (CY) 2020, CMS accepted the proposed values for the Auditory Function Evaluation codes: a recommended work relative value unit (RUV) of 1.40 for CPT code 92626, identical to its current RVU, and the recommended RVU of 0.33 for the add-on code, CPT code 92627. CMS also accepted the proposed

DESCRIPTION

92626 Evaluation of auditory function for candidacy or post-operative status of surgically implanted devices or other auditory treat-ment interventions; first hour

92627 Each additional 15 minutes (list separately in addition to code for primary procedure)

92548 Computerized dynamic pos-turography (six conditions)

(New) Computerized dynamic pos-92549 turography (six conditions) with

MCT and ADT

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CODING AND REIMBURSEMENT -

RUC-recommended direct practice expense (PE) inputs for these codes .

Despite solid survey data and a cogent presentation before the RUC by our col­leagues from AAN, the primary billers of this code, CMS opted not to accept the RUC recommended RVUs of 0.76 for CPT code 92548 and 0.96 for CPT code 92549. CMS has accepted alternate work RVUs that more closely align with the current valua­tion of 92458 than either the specialties or the AMA RUC recommended.

The proposed and anticipated changes to these codes are detailed in TABLE 1 below .

The Academy will continue to advo­cate for fair reimbursement for services provided by our members. We will continue to vigorously challenge CMS when it decides not to accept the RUC­recommended values. Gi

Erin L. Milller, AuD, is a professor of instruction at the University of Akron. Patricia Gaffney, AuD, is an associate professor at Nova Southeastern University. Both are members of the Academy's Practice Policy Advisory Council.

1.40 1.10 1.40 1.11

0.33 0.30 0.33 0.27

0.50 2.19 0.66 0.69

NA NA 0.86 0.89

Erratum

We apologize for the

error published in the

September/October 2019

issue of Audiology Today.

In the table on page 68,

for the Distinct Procedural

Service Code explanation,

the unbundled vestibular

codes should be listed

as "92541-59, 92542-59,

92544-59, and 92545-59 ."

TABLE 1. Estimated Payment Rates for Revised and New Codes in 2020

$91 .90 $92.75

$23 .07 $22.01

$98.03 $49.80

NA $64 .24

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