Bottom Line: New Coding Options for Diagnostic Analysis of Cochlear Implants What is the appropriate use of the new diagnostic cochlear implant codes? These FAQs were developed to answer specific questions members have posed to ASHA, and to assist members in better understanding the new codes and their use. What are the new cochlear implant CPT codes? A. Four new cochlear ... Bottom Line
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Bottom Line  |   April 01, 2003
Bottom Line: New Coding Options for Diagnostic Analysis of Cochlear Implants
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Hearing Aids, Cochlear Implants & Assistive Technology / Bottom Line
Bottom Line   |   April 01, 2003
Bottom Line: New Coding Options for Diagnostic Analysis of Cochlear Implants
The ASHA Leader, April 2003, Vol. 8, 3-25. doi:10.1044/leader.BML.08062003.3
The ASHA Leader, April 2003, Vol. 8, 3-25. doi:10.1044/leader.BML.08062003.3
What is the appropriate use of the new diagnostic cochlear implant codes? These FAQs were developed to answer specific questions members have posed to ASHA, and to assist members in better understanding the new codes and their use.
What are the new cochlear implant CPT codes?
A. Four new cochlear implant codes became effective March 1, 2003. They are:
  • 92601, diagnostic analysis of cochlear implant patient under 7 years of age, with analysis

  • 92602, subsequent re-analysis

  • 92603, diagnostic analysis of cochlear implant patient 7 years of age or older, with analysis

  • 92604, subsequent re-analysis

What are the reimbursement rates for these new codes?
A. For Medicare purposes, the 2003 reimbursement rates, which do not reflect geographic adjustments, are:
92601—$130.96
92602—$ 91.96
92603—$ 88.29
92604—$ 60.33
To calculate the Medicare reimbursement rate for a specific geographic location, download the 2003 Medicare Physician Fee Schedule for Audiologists from ASHA’s Web site.
The reimbursement rates for private payers vary from plan to plan. It is recommended that you contact the specific health plan to obtain their reimbursement rates.
Why did ASHA request that the AMA create new diagnostic cochlear implant codes?
A. ASHA requested that the AMA establish independent codes for diagnostic analysis of the cochlear implant to better describe to payers the service being performed. Until the new codes were introduced, audiologists and SLPs could only use CPT 92510 (Aural rehabilitation following cochlear implantation).
The descriptor for this code encompassed both diagnostic analysis of the cochlear implant speech processor and aural rehabilitation services subsequent to cochlear implantation. These are two separate and distinct services. CPT 92510 did not allow the audiologist to report to the payer when diagnostic analysis of the cochlear implant speech processor was performed without aural rehabilitation. The new codes allow for this distinction.
What is meant by diagnostic analysis?
A. Diagnostic analysis of the speech processor is a unique service that is critical to the safety and effectiveness of the cochlear implant system. This service is required after the initial fitting of the processor, usually four to six weeks after surgery, and periodically for the first year.
Diagnostic analysis includes adjustments to the stimulus parameters of the processor, which determine the signals delivered to the electrodes surgically implanted inside the cochlea. Diagnostic analysis of a cochlear implant can be performed only by an audiologist, whereas aural rehabilitation can be performed by an audiologist or a speech-language pathologist.
How do you bill for aural rehabilitation following cochlear implantation?
A. For Medicare purposes, CPT 92510 (aural rehabilitation following cochlear implant) will no longer be recognized. In the Dec. 31, 2002 Federal Register, the Center for Medicare and Medicaid Services (CMS) indicated that cochlear implant patients who need rehabilitation services can be seen by a speech-language pathologist whose services are reimbursed by Medicare by coding CPT 92507, a procedure with a descriptor that includes aural rehabilitation. Medicare covers only independently practicing audiologists for diagnostic services; however, aural rehabilitation is covered in hospital and physician provider settings.
Private payers are free to designate CPT 92510 for aural rehabilitation following cochlear implantation; however, providers are urged to contact the specific health plan to obtain their coverage policy.
Can audiologists bill for audiologic rehabilitation under Medicare?
A. ASHA’s Health Care Economics Committee will be addressing the need for separate audiologic rehabilitation procedures. In addition, ASHA is advancing federal legislation in the 108th Congress to have Medicare cover audiologic rehabilitation services by audiologists.
For additional information on the development of these codes, contact Steven White through the Action Center at 800-498-2071, ext. 4126, or by e-mail at swhite@asha.org.
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April 2003
Volume 8, Issue 6