IMPLANTABLE MAGNETIC TRANSCUTANEOUS BONE CONDUCTION HEARING SYSTEM REIMBURSEMENT CODING GUIDE
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1 IMPLANTABLE MAGNETIC TRANSCUTANEOUS BONE CONDUCTION HEARING SYSTEM REIMBURSEMENT CODING GUIDE This document provides general reimbursement information to assist in obtaining coverage and reimbursement for healthcare services. These coding suggestions do not replace seeking coding advice from the payer and/or your own coding staff. The ultimate responsibility for correct coding lies with the provider of services. Surgical codes provided below are verified with AMA, but some payers may recommend codes other than those listed. Please contact your local payer for interpretation of the appropriate codes to use for specific procedures. Reimbursement Support (855)
2 IMPLANTABLE MAGNETIC TRANSCUTANEOUS BONE CONDUCTION HEARING SYSTEM CODING GUIDE 2016 Surgical codes provided below are verified with AMA, but some payers may recommend codes other than those listed. PHYSICIAN CODING Code Surgical Services 1 Description for Implant Procedure Relative Value Units (RVU) 2 Facility Physician (Implant, no (Implant, with (Replace Implant, no (Replace Implant, with Implantation, osseointegrated implant, temporal bone, processor/cochlear stimulator; without mastoidectomy Implantation, osseointegrated implant, temporal bone, processor/cochlear stimulator; with mastoidectomy device), osseointegrated implant, temporal bone, processor/cochlear stimulator; without mastoidectomy device), osseointegrated implant, temporal bone, processor/cochlear stimulator; with mastoidectomy $1, $1, $1, $1,390 Code-Fitting 1 Description for Fitting Relative Value Units (RVU) 2 Non-Facility Physician Evaluation of auditory rehabilitation status, first hour (can be pre-op or post-op) Evaluation of auditory rehabilitation status; each additional 15 minutes 2.53 $ $ Unspecified otolaryngology service or procedure (intended to cover a variety of procedures that do not have their own codes; maybe used to cover the sound processor fitting ) 1. Current Procedural Terminology ( ). Copyright 2016 American Medical Association.
3 HOSPITAL OUTPATIENT AND AMBULATORY SURGICAL CENTER CODING Code Surgical Services 1 Description Surgical Procedure Classification (APC) Medicare National (HOPPS)³ Surgical Center (ASC) ³ (Implant, no Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/ cochlear stimulator; without mastoidectomy 5125 $10,538 $7,887 Status Indicator J (Implant, with Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/ cochlear stimulator; with mastoidectomy 5125 $10,538 $7,887 Status Indicator J (Replace implant, no device), osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy 5123 Status Indicator J1 Comprehensive APC $4,969 Status Indicator T Multiple Procedure Reduction Applies $2,486 Status Indicator G (Replace implant, with device), osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy 5124 $7,064 $3,533 Status Indicator G2 Code Fitting 1 Description for Fitting Classification (APC) Medicare National (HOPPS)³ Evaluation of auditory rehabilitation status, first hour (can be pre-op or post-op) 5721 Status Indicator Q1 $ Evaluation of auditory rehabilitation status; each additional 15 minutes Status Indicator N Unspecified otolaryngology service or procedure (intended to cover a variety of procedures that do not have their own codes; maybe used to cover the sound processor fitting) 5731 Status Indicator Q1 $13 1. Current Procedural Terminology ( ). Copyright 2016 American Medical Association. 3. Hospital Outpatient Prospective - Final CY2016 Rates- CMS-1633-FC/CMS-1607-F2.
4 ICD-10 CM DIAGNOSIS CODES ICD-9-CM Diagnosis Code - Description ICD-10 Diagnosis Code - Description H Conductive hearing loss, unspecified H Conductive hearing loss, bilateral H Conductive hearing loss, bilateral H Conductive hearing loss, unilateral, right ear, with unrestricted hearing on H Conductive hearing loss, bilateral H Conductive hearing loss, bilateral H Conductive hearing loss, bilateral NA H Conductive hearing loss, bilateral H Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on H Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on H Mixed conductive and sensorineural hearing loss, unspecified H Mixed conductive and sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on H Mixed conductive and sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on
5 DEVICE SUPPLY HCPCS CODES Configuration HCPCS Code Description Medicare Outpatient Status Indicator Alpha 1, Alpha 2 (M), Alpha 2 MPO (implant & processor) L8690 Auditory osseointegrated device, includes all internal and external components Status Indicator N Packaged, Not Paid Separately Alpha 1 and 2 (S) and Alpha 2 MPO (no implant, softband/headband & processor) L8692 Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external Status Indicator E Statutory Excluded Alpha 1 and 2, Alpha 2 MPO (replace existing processor) L8691 Auditory osseointegrated device, external sound processor, replacement Status Indicator A Paid under DME Fee Schedule 1. Current Procedural Terminology ( ). Copyright 2016 American Medical Association. 3. Hospital Outpatient Prospective - Final CY2016 Rates- CMS-1633-FC/CMS-1607-F2. Rx only. Refer to product instruction manual/package insert for instructions, warnings, precautions and contraindications. For further information, please call Medtronic ENT at and/or consult Medtronic s website at Medtronic plc ENT 6743 Southpoint Drive N Jacksonville, FL USA Toll free: (800) Telephone: (904) Fax: (800) International Telephone Numbers Adriatic Region Argentina Australia Baltic Region Belgium Brazil Canada Chile China Colombia Czech Republic France Germany Greece Hong Kong Hungary India Israel Italy Japan Korea Lebanon Luxembourg Malaysia Mexico Netherlands Poland Russian Fed Singapore South Africa Spain Taiwan Thailand UK Alpha 2 MPO is a trademark of Medtronic, Inc. 2016, Medtronic, Inc. UC aEN
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