The Impact of New Codes for the Evaluation of Central Auditory Function In a coding victory for audiologists, the ASHA Health Care Economics Committee (HCEC) negotiated two new Current Procedure Terminology (CPT)* codes for central auditory function assessment-the first audiology codes to include time designations. (See November 16, 2004 ASHA Leader for additional information on the CPT approval process). Robert Fifer and ... Bottom Line
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Bottom Line  |   August 01, 2005
The Impact of New Codes for the Evaluation of Central Auditory Function
Author Notes
  • Maureen Thompson, is ASHA’s director of private health plans advocacy.
    Maureen Thompson, is ASHA’s director of private health plans advocacy.×
Article Information
Hearing & Speech Perception / Practice Management / Bottom Line
Bottom Line   |   August 01, 2005
The Impact of New Codes for the Evaluation of Central Auditory Function
The ASHA Leader, August 2005, Vol. 10, 5-27. doi:10.1044/leader.BML.10102005.5
The ASHA Leader, August 2005, Vol. 10, 5-27. doi:10.1044/leader.BML.10102005.5
In a coding victory for audiologists, the ASHA Health Care Economics Committee (HCEC) negotiated two new Current Procedure Terminology (CPT)* codes for central auditory function assessment-the first audiology codes to include time designations. (See November 16, 2004 ASHA Leader for additional information on the CPT approval process). Robert Fifer and Thomas Rees, vice chair of the ASHA HCEC, along with other audiology members of the HCEC, spent nearly two years defending the new procedures before the American Medical Association (AMA) CPT Editorial Panel and the Health Care Professionals Advisory Committee of the AMA Relative Value Update (RUC) Committee.
The two new codes (effective January 2005) for central auditory function are:
  • 92620: Evaluation of central auditory function, with report; initial 60 minutes

  • 92621: Each additional 15 minutes

A shadow has been cast on this victory because the Centers for Medicare and Medicaid Services (CMS) severely undervalued the new codes in the Medicare Physician Fee Schedule, which resulted in very low reimbursement rates: $45.48 for 92620 and $11.75 for 92621 for national rates. Geographic indexes adjust the new rates according to the practice location. (See sidebar on how reimbursement rates are derived).
In an attempt to receive fair and equitable reimbursement for performing a comprehensive evaluation of central auditory function, audiologists have asked the ASHA National Office to clarify whether or not they may bill the new codes in combination with existing individual tests, such as Filtered Speech Test (92571), Staggered Spondaic Word Test (92572), and Synthetic Sentence Identification Test (92576). (Note: CPT 92589, which was a designator for otherwise non-codified central auditory function procedures, has been deleted.)
For current advice to assist audiology members, ASHA staff discussed this issue with a Medicare consultant and audiology members of ASHA’s HCEC. Based on these discussions, ASHA recommends that 92620 and 92621 not be billed in combination with 92571, 92572, or 92576. Our rationale is that an evaluation of central auditory function is part of a battery of site of lesion tests. CPT 92620 is intended to represent the first hour of that battery and CPT 92621 is intended to capture the procedure time required beyond the initial hour. Being time-based allows flexibility in the evaluation because individual tests need not be reported separately and the audiologist may capture the time spent performing diverse aspects of the evaluation.
Similarly, basic audiometry procedures (92552 and 92556) can not be billed separately because a comprehensive code exists to capture the procedures in combination (92557). However, peripheral site of lesion tests do not have any timed values or combination codes. They might be represented by a CPT code such as 92563 (tone decay), and infrequently used codes such as 92561 (diagnostic Bekesy), 92562 (loudness balance), and 92564 (SISI). Electrophysiologic tests in the battery might include 92585 (electrocochleography), and 92588 (comprehensive evoked otoacoustic emissions). These procedures may be billed in combination with 92557 and 92561. However, with central auditory testing, if any individual test procedures (92571, 92572 or 92576) are performed in isolation, then the single code representing that procedure can still be reported. But if, for example, a battery of tests is performed, one of which is 92572, then 92572 should not be used in addition to 92620.
The only guidance provided in the 2005 CPT manual is “Do not report 92620 or 92621 in conjunction with 92506 (evaluation of speech, language, voice, communication, auditory processing, and/or aural rehabilitation status). No guidance is offered with respect to the individual test codes referenced above.
* CPT © 2004 American Medical Association. All Rights Reserved.
How Are Reimbursement Rates Derived?

The reimbursement rate for all new procedures is derived from the Medicare Physician Fee Schedule. Currently, the valuation of most audiology procedure codes is based primarily on practice expense rather than on physician work. Practice expense is the actual time spent by the non-physician provider to perform the service. This time is then multiplied by the average salary cost per minute. Along with the clinical staff time, the value of equipment, supplies, and overhead are included in the formula for practice expense.

If codes are valued based primarily on physician work, then other factors such as technical skill, judgment, and psychological stress are incorporated into the valuation formula. When a procedure involves physician work as opposed to practice expense, it is typically more generously valued and, therefore, reimbursed at a higher level. ASHA continues to have discussions with CMS about the possibility of moving audiology and speech-language pathology services from practice expense to “work.” This would be comparable to the valuation now afforded physical therapy and occupational therapy services. While ASHA is actively working to achieve this change, the ultimate resolution is still very much uncertain. However, you may be assured that improving payment for audiology and services is the highest priority of the ASHA HCEC.

For questions or comments about this column, contact reimbursement@asha.org.

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August 2005
Volume 10, Issue 10