Navigating the Thicket of Billing for Cochlear Implant Services Reimbursement rules for CI-related services differ for audiology and speech-language pathology. Check out these key distinctions. Bottom Line
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Bottom Line  |   March 01, 2015
Navigating the Thicket of Billing for Cochlear Implant Services
Author Notes
  • Lisa Satterfield, MS, CCC-A, is director of ASHA health care regulatory advocacy. lsatterfield@asha.org
    Lisa Satterfield, MS, CCC-A, is director of ASHA health care regulatory advocacy. lsatterfield@asha.org×
  • Neela Swanson is director of ASHA health care coding policy. nswanson@asha.org
    Neela Swanson is director of ASHA health care coding policy. nswanson@asha.org×
Article Information
Speech, Voice & Prosodic Disorders / Hearing Disorders / Hearing Aids, Cochlear Implants & Assistive Technology / Practice Management / Bottom Line
Bottom Line   |   March 01, 2015
Navigating the Thicket of Billing for Cochlear Implant Services
The ASHA Leader, March 2015, Vol. 20, 28. doi:10.1044/leader.BML.20032015.28
The ASHA Leader, March 2015, Vol. 20, 28. doi:10.1044/leader.BML.20032015.28
Although Medicare coverage for cochlear implant services has been firmly established since 1998, billing for post-cochlear implant services can be unclear. In addition, the interdisciplinary approach used for cochlear implant candidacy evaluations and post-surgical services further blurs the lines for audiologists and speech-language pathologists, who often ask, “What do I bill?”
Cochlear implant evaluation
The audiometric evaluations performed by audiologists, and the CPT (Current Procedure Terminology, ©American Medical Association) codes assigned to them, are no different than those used for a standard evaluation. If the audiologist is working in a hospital facility, the billing will be submitted through the Outpatient Prospective Payment System, which uses the same CPT codes as outpatient services but reimburses through a bundled payment to the hospital.
Audiologists should perform, with a physician’s order, the diagnostic tests that are medically necessary to determine candidacy, including the evaluation of audiologic rehabilitation status for the first hour (CPT 92626) and each additional 15 minutes of evaluation (92627). These codes were designed with the cochlear implant benefit in mind.
SLPs also may use these audiologic rehabilitation status codes, or they may determine a more traditional speech-language evaluation (CPT 92523) is necessary. In either case, clinicians should make sure that local coverage determinations allow those codes and that documentation justifies the code(s) billed.
Post-surgical services
Billing post-surgical services is significantly different for audiologists and SLPs, partly because Medicare limits audiologists to diagnostic services only. Audiologists bill for “Diagnostic analysis … with programming” for the patient’s initial post-op programming (CPT 92601/92603) and subsequent analysis and programming sessions (CPT 92602/92604). Audiologists cannot bill Medicare for aural rehabilitation (CPT 92630, 92633) because of their diagnostic-only provider status.

Billing post-surgical services is significantly different for audiologists and SLPs, partly because Medicare limits audiologists to diagnostic services only.

SLPs also may not use the aural rehabilitation codes to bill Medicare, because the codes are not active in the Medicare claims processing system. Medicare specifies that SLPs should use CPT 92507/92508 (Treatment of speech, language, voice, communication, and/or auditory processing disorder, individual/group) for aural rehabilitation.
Other insurance
Medicaid and private insurance programs often—but not always—adopt Medicare policies for their own coverage rules. Despite the availability of billing codes for audiologic rehabilitation, for example, not all private health plans cover it. To determine what services are covered and how they should be coded, contact the patient’s insurance provider.
1 Comment
March 4, 2015
Tamala Bradham
G-Codes
Wonderful reminder for coding for cochlear implant services. It is also worth mentioning that for Medicare patients, speech-language pathologists need to include claim based outcome reporting in their notes. Using ASHA's NOMs is recommended in selecting the appropriate G-Codes.
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March 2015
Volume 20, Issue 3