Question
PART I I am looking for a CPT code for Universal Newborn Hearing screens that we are now doing on all newborns in our hospital. Can you help me?
Answer
The CPT codes to use for infant hearing screening are: 92586 Auditory evoked potentials, limited, or 92587 Evoked acoustic emission, limited.
PART II I am an employee of an ENT who recently went to a ''coding'' course and was told that audiologists should not be using the ''global'' code of 92585 for billing ABRs. It was stated that audiologists are not allowed to bill for the professional component of this code (only the technical component) and should therefore be billing it with the TC modifier. I have always done the testing and the interpretation and received reimbursement for both, from Medicare, by using the 92585 code.
Audiologists in independent practice can only bill Medicare for the technical component (TC) of ABRs. However, if the audiologist is in a physician's office, global billing is appropriate when the physician is involved with the patient's care. This billing differentiation is due to the structure of the Medicare physician fee schedule where only physicians (as defined in the Medicare statute) can be reimbursed for the work RVU.
Steven C. White, Ph.D. Director Health Care Economics and Advocacy American Speech-Language-Hearing Association phone 301-897-0126 fax 301-897-7356
Steven C. White, PhD, CCC-A
Director of the Health Care Economics and Advocacy at the ASHA National Office.
Steven C. White, PhD, CCC-A, is the Director of the Health Care Economics and Advocacy at the ASHA National Office. White, an ASHA Fellow, is ex officio to the Health Care Economics Committee. His responsibilities include Medicare, private health insurance and Medicaid especially coding and outpatient reimbursement policies as they relate to these payers. White is the staff liaison to the American Medical Association Current Procedural Terminology Editorial Panel and the AMA Relative Value Update Committee. He has published and presented extensively on third party reimbursement. White is co-author with Janet McCarty of Health Plan Coding and Claims Guide (2005), Negotiating Health Care Contracts and Calculating Fees (2004), Appealing Health Plan Denials, and Getting Your Services Covered. White is also coauthor with Ingrida Lusis and Mark Kander of the Medicare Handbook for Audiologists (2005). White holds a PhD in audiology from Wayne State University and an MS in speech-language pathology and audiology from Ithaca College.
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