IHCP banner page INDIANA HEALTH COVERAGE PROGRAMS BR MARCH 1, 2016
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1 IHCP banner page INDIANA HEALTH COVERAGE PROGRAMS BR MARCH 1, 2016 IHCP creates separate Hearing Aid Dealer and Audiologist code sets Effective April 1, 2016, the Indiana Health Coverage Programs (IHCP) will separate the current Hearing Services Code Set into two code set tables one for hearing aid dealers and one for audiologists. The Hearing Aid Dealers Code Set (Table 1) will list the covered procedure codes billable by provider specialty 220. The Audiologist Code Set (Table 2) will list the covered procedure codes billable by provider specialty 200. The procedure codes in both code sets will be updated to reflect current IHCP policy. This change applies to dates of service (DOS) on and after April 1, The new code sets are included in this banner as attachments and will be posted to the Code Sets page at indianamedicaid.com in the next monthly update. QUESTIONS? If you have questions about this publication, please contact Customer Assistance at COPIES OF THIS PUBLICATION If you need additional copies of this publication, please download them from indianamedicaid.com. SIGN UP FOR IHCP NOTIFICATIONS To receive notices of IHCP publications, subscribe by clicking the blue subscription envelope here or on the pages of indianamedicaid.com. TO PRINT A printer-friendly version of this publication, in black and white and without graphics, is available for your convenience. 1 of 6
2 Procedure Code Table 1 Hearing aid dealer code set for provider specialty 220 for DOS on or after April 1, 2016 Description Screening test, pure tone, air only Pure tone audiometry (threshold); air only Pure tone audiometry (threshold); air and bone Speech audiometry threshold; Speech audiometry threshold; with speech recognition Comprehensive audiometry threshold evaluation and speech recognition (92553 and combined) Bekesy audiometry; screening Bekesy audiometry; diagnostic Loudness balance test, alternate binaural or monaural Tone decay test Short increment sensitivity index (SISI) Stenger test, pure tone Hearing aid examination and selection; monaural Hearing aid examination and selection; binaural Hearing aid check; monaural Hearing aid check; binaural Electroacoustic evaluation for hearing aid; monaural Electroacoustic evaluation for hearing aid; binaural L7510 Repair of prosthetic device, repair or replace minor parts V5010 Assessment for hearing aid V5014 Repair/modification of a hearing aid V5020 Conformity evaluation V5030 Hearing aid, monaural, body worn, air conduction V5040 Hearing aid, monaural, body worn, bone conduction V5050 Hearing aid, monaural, in the ear V5060 Hearing aid, monaural, behind the ear V5080 Glasses, bone conduction V5095 Semi-implantable middle ear hearing prosthesis V5100 Hearing aid, bilateral, body worn V5120 Binaural, body (hearing aid) V5130 Binaural, in the ear (hearing aid) V5140 Binaural, behind the ear (hearing aid) V5160 Dispensing fee, binaural V5170 Hearing aid, CROS, in the ear V5180 Hearing aid, CROS, behind the ear V5210 Hearing aid, BICROS, in the ear V5220 Hearing aid, BICROS, behind the ear 2 of 6
3 Table 1 Hearing aid dealer code set for provider specialty 220 for DOS on or after April 1, 2016 (continued) V5241 V5246 V5247 V5252 V5253 V5256 V5257 V5260 V5261 V5264 V5266 V5267 V5299 Dispensing fee, monaural hearing aid, any type Hearing aid, digitally programmable analog, monaural, ITE (in the ear) Hearing aid, digitally programmable analog, monaural, BTE (behind the ear) Hearing aid, digitally programmable, binaural, ITE Hearing aid, digitally programmable, binaural, BTE Hearing aid, digital, monaural, ITE Hearing aid, digital, monaural, BTE Hearing aid, digital, binaural, ITE Hearing aid, digital, binaural, BTE Ear mold/insert, not disposable, any type Battery for use in hearing device Hearing aid or assistive listening device/supplies/accessories, not otherwise specified Hearing service miscellaneous 3 of 6
4 Table 2 Audiologist code set for provider specialty 200 for DOS on or after April 1, 2016 Procedure Description Code Removal impacted cerumen requiring instrumentation, unilateral Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals Facial nerve function studies (eg, electroneuronography) Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording Positional nystagmus test, minimum of 4 positions, with recording Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes 4 tests), with recording Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording Oscillating tracking test, with recording Sinusoidal vertical axis rotational testing Use of vertical electrodes (List separately in addition to code for primary procedure) Computerized dynamic posturography Tympanometry and reflex threshold measurements Screening test, pure tone, air only Pure tone audiometry (threshold); air only Pure tone audiometry (threshold); air and bone Speech audiometry threshold; Speech audiometry threshold; with speech recognition Comprehensive audiometry threshold evaluation and speech recognition (92553 and combined) Bekesy audiometry; screening Bekesy audiometry; diagnostic Loudness balance test, alternate binaural or monaural Tone decay test Short increment sensitivity index (SISI) Stenger test, pure tone Tympanometry (impedance testing) Acoustic reflex testing, threshold Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing Filtered speech test Staggered spondaic word test Sensorineural acuity level test Synthetic sentence identification test Stenger test, speech Visual reinforcement audiometry (VRA) Conditioning play audiometry Select picture audiometry Electrocochleography 4 of 6
5 Table 2 Audiologist code set for provider specialty 200 for DOS on or after April 1, 2016 (continued) Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; limited Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report Hearing aid examination and selection; monaural Hearing aid examination and selection; binaural Hearing aid check; monaural Hearing aid check; binaural Electroacoustic evaluation for hearing aid; monaural Electroacoustic evaluation for hearing aid; binaural Ear protector attenuation measurements Diagnostic analysis of cochlear implant, patient younger than 7 years of age; with programming Diagnostic analysis of cochlear implant, patient younger than 7 years of age; subsequent reprogramming Diagnostic analysis of cochlear implant, age 7 years or older; with programming Diagnostic analysis of cochlear implant, age 7 years or older; subsequent reprogramming Evaluation for prescription for speech-generating augmentative and alternative communication device, face-toface with the patient; first hour Evaluation for prescription for speech-generating augmentative and alternative communication device, face-toface with the patient; each additional 30 minutes (List separately in addition to code for primary procedure) Therapeutic services for the use of speech-generating device, including programming and modification Evaluation of central auditory function, with report; initial 60 minutes Evaluation of central auditory function, with report; each additional 15 minutes (List separately in addition to code for primary procedure) Assessment of tinnitus (includes pitch, loudness matching, and masking) Evaluation of auditory rehabilitation status; first hour Evaluation of auditory rehabilitation status; each additional 15 minutes (List separately in addition to code for primary procedure) Auditory rehabilitation; prelingual hearing loss Auditory rehabilitation; postlingual hearing loss Diagnostic analysis with programming of auditory brainstem implant, per hour Unlisted otorhinolaryngological service or procedure Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities Checkout for orthotic/prosthetic use, established patient, each 15 minutes L7510 L8614 L8615 L8619 S0618 V5010 V5014 V5020 V5030 Repair of prosthetic device, repair or replace minor parts Cochlear device, includes all internal and external components Headset/headpiece for use with cochlear implant device, replacement Cochlear implant, external speech processor and controller, integrated system, replacement Audiometry for hearing aid evaluation to determine the level and degree of hearing loss Assessment for hearing aid Repair/modification of a hearing aid Conformity evaluation Hearing aid, monaural, body worn, air conduction 5 of 6
6 Table 2 Audiologist code set for provider specialty 200 for DOS on or after April 1, 2016 (continued) V5040 Hearing aid, monaural, body worn, bone conduction V5050 Hearing aid, monaural, in the ear V5060 Hearing aid, monaural, behind the ear V5080 Glasses, bone conduction V5095 Semi-implantable middle ear hearing prosthesis V5100 Hearing aid, bilateral, body worn V5120 Binaural, body (hearing aid) V5130 Binaural, in the ear (hearing aid) V5140 Binaural, behind the ear (hearing aid) V5160 Dispensing fee, binaural V5170 Hearing aid, CROS, in the ear V5180 Hearing aid, CROS, behind the ear V5210 Hearing aid, BICROS, in the ear V5220 Hearing aid, BICROS, behind the ear V5241 Dispensing fee, monaural hearing aid, any type V5246 Hearing aid, digitally programmable analog, monaural, ITE (in the ear) V5247 Hearing aid, digitally programmable analog, monaural, BTE (behind the ear) V5252 Hearing aid, digitally programmable, binaural, ITE V5253 Hearing aid, digitally programmable, binaural, BTE V5256 Hearing aid, digital, monaural, ITE V5257 Hearing aid, digital, monaural, BTE V5260 Hearing aid, digital, binaural, ITE V5261 Hearing aid, digital, binaural, BTE V5264 Ear mold/insert, not disposable, any type V5266 Battery for use in hearing device V5267 Hearing aid or assistive listening device/supplies/accessories, not otherwise specified V5299 Hearing service miscellaneous 6 of 6
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