Wiki Billing for an Epley (Canalith Repositioning Maneuver)

[Sheri Varner]

I work in an ENT office that I bill Audiology services as well as Otolaryngology.

I have heard through the grape vine that only MCR will not cover this service due to not recognizing the Audiologist as performing this type of therapy (CPT code used: 95992), however does this include all contracted/commercial insurances?

So my question is this: If a patient is scheduled for an Epley (not on same day as seeing a physician) with one of our Audiologist, will insurance not cover the service performed, period? What about billing "incidental to" (in office supervising physician)?

What are your suggestions and/ or experience on this CPT code 95992? Anyone bill an Epley with CPT code 97112?

Thank you.

Sheri Varner
Coding Specialist
St. John's Clinic -
Ear, Nose & Throat / Audiology
Springfield, MO

 

[sbiegler]

Good question! I've wondered about this as well. I work in the same sitation, where I not only bill the ENT but the Audio as well. We are currently not receiving any reimbursement from the insurance companies for the Epley performed by the Audiologists. I am interested to know if anyone is having any luck in getting paid by any insurance company for it.

 

[cgallimore]

I say this would really vary by payer. You may have to take a "payer poll" and find out. Some of them may be following Medicare's policy stating "there is no provision in the law for Medicare to pay audiologists for therapeutic services." You should be able to bill incident-to, as long as the incident-to guidelines are followed. There is a good article in the Coding Edge 2009 edition on "Seven Tips for Audiologist Billing Success".

Also, since the code for the Epley Maneuver is still fairly new, some payers may still see it as 'investigational' or 'it has not been proven to be an effective therapy', thus causing denials as well.

Good luck - hope you get these paid.