Audiologists Win Coding Gains in 2003 A two-year effort by ASHA’s Health Care Economics Committee (HCEC) resulted in a major victory for audiologists in the area of billing codes for cochlear implant programming procedures. The Centers for Medicare and Medicaid Services (CMS) will include four new diagnostic codes for cochlear implant procedures in the 2003 Medicare ... Bottom Line
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Bottom Line  |   January 01, 2003
Audiologists Win Coding Gains in 2003
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Hearing Aids, Cochlear Implants & Assistive Technology / Audiologic / Aural Rehabilitation / Practice Management / Regulatory, Legislative & Advocacy / ASHA News & Member Stories / Bottom Line
Bottom Line   |   January 01, 2003
Audiologists Win Coding Gains in 2003
The ASHA Leader, January 2003, Vol. 8, 1-28. doi:10.1044/leader.BML.08012003.1
The ASHA Leader, January 2003, Vol. 8, 1-28. doi:10.1044/leader.BML.08012003.1
A two-year effort by ASHA’s Health Care Economics Committee (HCEC) resulted in a major victory for audiologists in the area of billing codes for cochlear implant programming procedures.
The Centers for Medicare and Medicaid Services (CMS) will include four new diagnostic codes for cochlear implant procedures in the 2003 Medicare Physician Fee Schedule. CMS also confirmed in a meeting with ASHA that these new procedures are diagnostic in nature and therefore can be performed independently by audiologists. In addition, these services will not count against the $1,500 Medicare caps for outpatient therapy, which are due to go back into effect in 2003 after a three-year moratorium.
The Current Procedure Terminology (CPT) codes for the new diagnostic cochlear implant procedures include:
  • 92601 —Diagnostic analysis of cochlear implant in a patient under 7 years of age, with programming

  • 92602 —Subsequent reprogramming

  • 92603 —Diagnostic analysis of cochlear implant in a patient 7 years of age or older, with programming

  • 92604 —Subsequent reprogramming

ASHA’s HCEC developed these new procedures and received approval for them from the American Medical Association (AMA) CPT Editorial Panel. The HCEC also developed data for practice expense values and presented them to the Health Care Professionals Advisory Committee within the AMA relative value process.
A consequence of the new diagnostic analysis of cochlear implant procedures is the exclusion of coverage by Medicare of the specific procedure for aural rehabilitation following cochlear implant (92510). CMS wrote “… (92510) will no longer be used for Medicare services since it represents services which have considerable overlap with the services described by the new CPT codes….” CMS stated that services that do not involve cochlear implant reprogramming should be billed to CPT 92507 “Treatment of speech, language, voice, communication, and/or auditory processing disorder (includes aural rehabilitation); individual” which describes the services, so a specific code for cochlear implants is no longer needed.
There is a $54.31 difference in the fee for 92507 from 92510. However, if programming ($83.02 for 7 years of age or older) or reprogramming ($56.73 for 7 years of age or older) and aural rehabilitation are performed on the same day, both can be billed to Medicare. The HCEC has been working on the development of appropriate audiologic rehabilitation procedures because of the confusion that CPT 92507 creates for payers when an audiologist bills for the procedure.
Conversion Factor Decreases
The fee schedule was expected in early November, but CMS did not publish the document in The Federal Register until Dec. 31. The 2003 Medicare Physician Fee Schedule sets the reimbursement rates for all Part B services and will take effect on March 1, 2003. CMS has requested that providers not submit claims for new CPT codes until that date. Services provided between Jan. 1 and March 1 will be paid under the 2002 Fee Schedule. Under the final rule, the conversion factor, which adjusts the base formula for all Medicare physician services, will be reduced by 4.4% beginning March 1. The formula is mandated by the Medicare and Medicaid and SCHIP Benefits Improvement and Protection Act of 2000.
“CMS has done everything it can to shore up physician payments for 2003, but only Congress has the authority to fix the formula,” said CMS Administrator Tom Scully in a press release.
ASHA will continue working closely with the AMA and allied provider groups to urge Congress to remedy the decrease in the conversion factor.
The new audiology diagnostic procedures are part of 17 new codes introduced in the 2003 Fee Schedule for procedures related to the professions. ASHA is currently analyzing the final rule and will provide further coverage in an upcoming issue of The ASHA Leader. For more information, contact Ingrida Lusis, by phone through the Action Center at 800-498-2071, ext. 4482 or by e-mail at ilusis@asha.org; or Mark Kander at ext. 4139 or by e-mail at mkander@asha.org.
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January 2003
Volume 8, Issue 1