Audiologists who provide diagnostic testing for the hearing and vestibular systems to Medicare beneficiaries must bill Medicare directly for their services. These services cannot be billed "incident to" a physician, because they are a defined benefit for audiologists.
What is the CPT code for vestibular evaluation?
The basic vestibular evaluation (92540) is a bundled code, defined as including: 92545, Oscillating tracking test, with recording. These procedural components must be included in their entirety, including a minimum of four positional tests.
When to use the-59 modifier for vestibular evaluation?
When using the -59 modifier, make sure there is appropriate documentation in the report as to why the full basic vestibular evaluation was not performed. It is inappropriate to unbundle the vestibular evaluation code for the sole purpose of higher reimbursement by billing the components separately.
How do you Bill an audiologist for a Medicare claim?
The National Provider Identifier (NPI) and name of the physician ordering the audiology evaluation must be included on the claim form. Audiologists who provide diagnostic testing for the hearing and vestibular systems to Medicare beneficiaries must bill Medicare directly for their services.
What are the Medicare rules for student audiologist evaluations?
According to Medicare rules, when a Medicare beneficiary is being evaluated by a student they must be 100% supervised by the licensed audiologist. For any services performed by a student, the audiologist must be in the room, guiding the student, fully engaged in the evaluation, and not performing any other tasks.
Does Medicare cover vestibular testing?
Diagnostic tests are not payable by Medicare unless directly used in the patient's care. Vestibular function testing (VFT) is covered for the purpose of determining the appropriate medical or surgical treatment of disorders in the vestibular system.
Does CPT 92551 need a modifier?
Vision and hearing screening (92551,99173) are payable in addition to other evaluation and management codes. Modifier -25 is not required on the claim for payment.
What is included in CPT code 92557?
Table 1: Services and Procedures Covered Under the Audiology BenefitCPT CodeDescriptor92557Comprehensive audiometry threshold evaluation and speech recognition92561Bekesy; diagnostic92562Loudness balance test, alternate binaural or monaural92563Tone decay test55 more rows
How do you bill VNG?
Another option that some members have used is to record the procedure with infrared VNG goggles and bill CPT code 92542, positional nystagmus testing (1 unit) and 1 unit of CPT code 92547 use of vertical electrodes.
Does Medicare pay for CPT 92557?
CPT® code 92557 will also be covered if ordered and performed in conjunction with Vestibular Function Testing (VFT), instead of CPT® code 92553, when the speech recognition component of the CPT® code 92557 is reasonable and necessary in the diagnosis or treatment of an individual Medicare beneficiary (e.g., Vestibular ...
What is the SK modifier?
SK - Member of high risk population (use only with codes for immunization)
Is CPT 92557 bilateral?
Bone conduction testing must be completed to bill 92557. b. 92557 is a bilateral code.
Who can Bill 92557?
audiologistA diagnostic hearing test (92557) is completed by an audiologist employed by a physician and is billed as "incident to" using the physician's NPI to bill Medicare.
Does 99173 require a modifier?
99173 with an E/M service When billing for a separately identifiable service on the same date as an E/M service, the modifier −25 should be appended to the E/M code (for instance, 99213-25.) Payers may choose to bundle code 99173 with the E/M service despite the correct modifier usage.
What is the CPT code for a VNG?
SAMPLE VNG / BALANCE PLATE TEST # 3CPT CODEUNITSMODIFIER925401NONE925371NONE925461NONE2 more rows
Does Medicare cover 95992?
Chapter 5, Part B Outpatient Rehabilitation Billing, is updated to indicate that CPT code 95992, a new code effective 1/1/09, is bundled under the Medicare Physician Fee Schedule (MPFS). This code is bundled with any therapy code.
What is vestibular testing?
Vestibular testing, also referred to as vestibular function testing or VFTs, is a series of tests that can evaluate hearing function. The goal of the tests is to determine if there is damage to the vestibular portion of the inner ear. The vestibular area of the ear controls balance.
Document Information
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Title XVIII of the Social Security Act, §1862 (a) (7) excludes routine physical examinations. Title XVIII of the Social Security Act, §1862 (a) (1) (A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. Title XVIII of the Social Security Act, §1861 (ll) (3) and (ll) (4) (B) defines Speech-Language Pathology Services and Audiology Services. CMS Internet-Only Manual, Pub.
Coverage Guidance
This policy addresses diagnostic testing of the vestibular system. Vestibular tests are tests of function, designed to identify a potential cause of balance problems. Their purpose is to determine if there is a problem with the vestibular portion of the brainstem and inner ear.
What is a case 1 vestibular evaluation?
Case 1. You are completing a vestibular evaluation on a patient with a neck injury. Due to this injury, the patient cannot complete any positional tests. You complete the gaze, optokinetic, and oscillating tracking tests. You also are able to complete warm and cool irrigations in both ears.
What is a bundled CPT code?
The American Medical Association (AMA) (2016) has identified several CPT codes that are considered “bundled.”. A bundled code includes procedures that are most often billed together. Instead of billing all of the individual procedures, just the one bundled code would be reported.
When was Eclipse approved?
In March 2017, the U.S. Food and Drug Administration (FDA) approved the Eclipse with VEMP system for the intended use of assessment of vestibular function (U.S. Food and Drug Administration, 2017). This is an important first step in demonstrating that VEMP testing is not an experimental/investigational procedure and beginning the process ...
Do you report the individual codes for vestibular evaluation?
Instead, you report the individual codes for the procedures that were performed. However, since the intent of the basic vestibular evaluation is bundled to include four components, when filing the claim for this evaluation a modifier must be added to indicate the procedure was not completed as intended.
What is Medicare benefit policy manual?
The Medicare Benefit Policy Manual at Chapter 15, Section 80.3 [PDF], defines the audiology benefit, qualifications, and other policy criteria necessary for audiologists providing services to Medicare beneficiaries.
What is a hearing evaluation?
evaluation of the cause of disorders of hearing, tinnitus, or balance; evaluation of suspected change in hearing, tinnitus, or balance; determination of the effect of medication, surgery, or other treatment; reevaluation to follow up regarding changes in hearing, tinnitus, or balance that may be caused by established diagnoses ...
How many hours of supervised clinical practicum for audiology?
successfully completed or is in the process of accumulating 350 clock hours of supervised clinical practicum, performed not less than 9 months of supervised full-time audiology services after obtaining a master's or doctoral degree in audiology, successfully completed a national examination in audiology approved by the Secretary.
Does Medicare cover audiologist testing?
Medicare Coverage of Audiologic Diagnostic Testing. Medicare covers audiologic diagnostic testing provided by an audiologist when a physician or non-physician practitioner (nurse practitioner, clinical nurse specialist, or physician’s assistant) orders the evaluation for the purpose of informing the physician's diagnostic medical evaluation ...
Do you need a physician order for audiology?
A physician order is required prior to the provision of audiology services . If a beneficiary undergoes diagnostic testing performed by an audiologist without a physician order, the tests are not covered, even if the audiologist discovers a pathologic condition.
Do audiologist have to opt out of Medicare?
Audiologists do not have an "opt-out" provision in their definition that allows private contracts with Medicare beneficiaries. If the service is covered by Medicare, there is a mandatory claim submission as defined in law (Social Security Act, Section 1848).
Does Medicare require a physician to be on site?
Direct supervision requires the physician to be on site and immediately available, but does not require the physician's presence in the room when the procedure is performed. According to Medicare rules, when a Medicare beneficiary is being evaluated by a student they must be 100% supervised by the licensed audiologist.
What does 59 mean in vestibular evaluation?
In a situation in which all four of the component procedures of the vestibular evaluation were not completed, a “-59” would be added to each of the individual codes that were performed to indicate that they were separate and distinct diagnostic procedures to indicate a distinct procedural service.
What is the code for SVV?
Currently, there are no codes available for these procedures. SVV can be assessed using a rotary chair, in which case, the Academy recommends coding 92700, unlisted otorhinolaryngological service or procedure, with its required documentation would be appropriate.
When to use 92547?
92547 should only be used when scleral coil electrodes (or surface electrodes) are used when performing electronystagmography (ENG) testing. Vertical tracking with VNG goggles does not satisfy the conditions for using 92547.
Is caloric irrigation included in vestibular evaluation?
Caloric irrigations are not included as part of the basic vestibular evaluation and should be billed separately. There are two codes for caloric irrigations: 92537, Caloric vestibular test with recording, bilateral; bithermal, (i.e., one warm and one cool irrigation in each ear for a total of four irrigations) ...
Is sensory organization testing CPT?
There is currently no specific CPT code for sensory organization testing. Sensory organization testing conducted on its own or with foam without the use of a dynamic platform would be considered a screening test, and would not be reimbursed by most third-party payers.
Is 92700 a billable service?
As a reminder, modifiers are not typically used when using 92700, nor is it customary to bill multiple units of this code .
Does Medicare cover audiologist?
This procedure is not covered by Medicare when completed by an audiologist, as Medicare does not cover treatment services provided by audiologists. It is best to check with your individual third party-payers on if they will reimburse this procedure, as each private health plan develops its own coverage position.
What is the CPT code for the Dix-Hallpike?
As noted earlier, CPT code 92542 is also included as part of the basic vestibular evaluation (92540). If performed in isolation, 92542 should be reported with the modifier 59 to indicate a distinct procedural service
What is CPT code 92540?
CPT code 92540 (basic vestibular evaluation ) includes all the services separately included in CPT codes 92541 (spontaneous nystagmus test), 92542 (positional nystagmus test), 92544 (optokinetic nystagmus test), and 92545 (oscillating tracking test). Therefore, none of the component test CPT codes (92541, 92542, 92544, and 92545) may be reported with CPT code 92540. Additionally, if all four component tests are performed, CPT code 92540 should be reported rather than the four separate individual CPT codes. If one, two, or three of the component tests are performed without the others, the individual test codes may be reported separately. However, if two or three component test codes are reported, NCCI-associated modifiers should be utilized
Can NCCI test codes be reported separately?
If one, two, or three of the component tests are performed without the others, the individual test codes may be reported separately. However, if two or three component test codes are reported, NCCI-associated modifiers should be utilized.
Do you report the individual codes for vestibular evaluation?
Instead, you report the individual codes for the procedures that were performed. However, since the intent of the basic vestibular evaluation is bundled to include four components, when filing the claim for this evaluation a modifier must be added to indicate the procedure was not completed as intended.
