Part B Insider (Multispecialty) Coding Alert

Published on Mon Sep 11, 2006 PDF

Find out how you can receive an extra $22

A few months have passed and you should now be familiar with the new codes to report evaluation of auditory rehabilitation status. Here's why.

CPT 2006 added four new auditory rehabilitation codes that took effect Jan.1, 2006:

• 92626--Evaluation of auditory rehabilitation status; first hour

• +92627--... each additional 15 minutes (list separately in addition to code for primary procedure)

• 92630--Auditory rehabilitation; pre-lingual hearing loss

• 92633--... post-lingual hearing loss.

Good news: You can now "bill Medicare for auditory rehabilitation assessment codes 92626 and 92627 because they are diagnostic in nature," says Steven White, PhD, director of healthcare economics and advocacy for the American Speech-Language-Hearing Association (ASHA) based in Rockville, Md.

Codes 92626 and 92627 both have nonfacility RVU totals of 0.61. Multiply the RVUs by the 2006 conversion factor of 36.1770 and you can see that these codes may bring in an estimated $22.07 each.

Don't forget: Carefully document the amount of time you spend with the patient or family when you evaluate auditory rehabilitation status. "Use the face-to-face time with the patient or family" to calculate the time for codes 92626 and 92627, instructs CPT 2006.

Bad news: Medicare won't reimburse you for 92630 and 92633. This decision reflects Medicare's "definition of audiology as a diagnostic profession only," says Robert Fifer, PhD, director of audiology and speech-language pathology at the Mailman Center for Child Development in Miami.

In the final fee schedule, the Centers for Medicare and Medicaid Services (CMS) wrote, "we will not recognize CPT codes 92630 and 92633 under Medicare and have assigned a status indicator of "I" because these services represent therapeutic services rather than diagnostic tests," White says. Status indicator "I" means that the code is not valid for Medicare purposes.