Audiologists Gain New Reimbursement Codes for 2005

In another coding gain for audiologists, the ASHA Health Care Economics Committee (HCEC) negotiated three new Current Procedure Terminology (CPT)* codes for tinnitus assessment and central auditory function assessment, the first audiology codes to include time designations. The coding victory for audiologists represents almost two years of work by the HCEC. The codes were developed in collaboration with other organizations representing audiology.

The 2005 Medicare Physician Fee Schedule (MPFS) will include the three procedures and their reimbursement rates. The MPFS is expected to be published in the Federal Register on November 15, 2004 and include the following new codes and descriptors, effective Jan. 1, 2005:

• 92620: Evaluation of central auditory function, with report; initial 60 minutes;
  
  
• 92621: Each additional 15 minutes; and
  
  
• 92625: Assessment of tinnitus (includes pitch, loudness matching, and masking).

The guidance that appears with the central auditory function codes in the 2005 CPT Manual is "Do not report 92620 or 92621 in conjunction with 92506." The 92506 code is untimed for the evaluation of speech, language, voice, communication, auditory processing, and/or aural rehabilitation status. Guidance regarding tinnitus assessment states that the loudness balance test (92562) cannot be billed on the same day as 92625.

The central auditory function codes are the first audiology codes to include time designations. There are specific rules issued by the Centers for Medicare and Medicaid Services (CMS) for use of fifteen minute codes:

• > 8 minutes and
  
• > 23 minutes and
  
• > 38 minutes and The conversion factor, the multiplier that converts relative value units to payment amounts, was increased from the 2004 level by 1.5% to $37.8975. Audiology services for 2005 increased by approximately 1.5% on average. ASHA's 2005 Medicare Fee Schedule for Audiologists will be available to ASHA members within the next week and at the upcoming ASHA Annual Convention in Philadelphia, November 18-20. An expanded article on how these new codes were obtained is scheduled to appear in the November 16 edition of the ASHA Leader. For further information, please contact Mark Kander, ASHA's Director of Health Care Regulatory Analysis, by phone at 800-498-2071, ext. 4139, or via e-mail at mkander@asha.org; or Ingrida Lusis, ASHA's Director of Health Care Regulatory Advocacy, via e-mail at ilusis@asha.org or at 800-498-2071, ext. 4482.
  
  * CPT© 2004 American Medical Association. All Rights Reserved.