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) 556-1307 sophono@emersonconsultants.com
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 2 69714 (Implant, no 69715 (Implant, with 69717 (Replace Implant, no 69718 (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 31.17 $1,116 38.44 $1,376 32.73 $1,172 38.83 $1,390 Code-Fitting 1 Description for Fitting Relative Value Units (RVU) 2 Non-Facility Physician 2 92626 92627 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 $91 0.63 $23 92700 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.
HOSPITAL OUTPATIENT AND AMBULATORY SURGICAL CENTER CODING Code Surgical Services 1 Description Surgical Procedure Classification (APC) 3 2016 Medicare National (HOPPS)³ Surgical Center (ASC) ³ 69714 (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 J8 69715 (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 J8 69717 (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-2 69718 (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) 3 2016 Medicare National (HOPPS)³ 92626 Evaluation of auditory rehabilitation status, first hour (can be pre-op or post-op) 5721 Status Indicator Q1 $130 92627 Evaluation of auditory rehabilitation status; each additional 15 minutes Status Indicator N 92700 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.
ICD-10 CM DIAGNOSIS CODES ICD-9-CM Diagnosis Code - Description ICD-10 Diagnosis Code - Description 389.00 H90.2 - Conductive hearing loss, unspecified 389.01 H90.0 - Conductive hearing loss, bilateral 389.02 H90.0 - Conductive hearing loss, bilateral H90.11- Conductive hearing loss, unilateral, right ear, with unrestricted hearing on 389.03 H90.0 - Conductive hearing loss, bilateral 389.04 H90.0 - Conductive hearing loss, bilateral 389.05 389.06 H90.0 - Conductive hearing loss, bilateral 389.07 NA 389.08 H90.0 - Conductive hearing loss, bilateral 389.17 H90.41 - Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on H90.42 - Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on 389.20 H90.8 - Mixed conductive and sensorineural hearing loss, unspecified 389.21 H90.71 - Mixed conductive and sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on H90.72 - Mixed conductive and sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on
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 800.874.5797 and/or consult Medtronic s website at www.medtronicent.com. Medtronic plc ENT 6743 Southpoint Drive N Jacksonville, FL 32216 USA Toll free: (800) 874-5797 Telephone: (904) 296-9600 Fax: (800) 678-3995 International Telephone Numbers Adriatic Region 385-1-488-1120 Argentina 54-11-4898-5700 Australia 1-800-668-670 Baltic Region 37-1-67560226 Belgium 32-2456-09-09 Brazil 55-11-2182-9200 Canada 1-800-217-1617 Chile 56-2-2655-5110 China 86-21-20325888 Colombia 57-1-742-7300 Czech Republic 420-2-9657-9580 France 33-470-679-800 Germany 49-2159-8149-209 Greece 30-210-67-79-099 Hong Kong 852-2919-1312 Hungary 36-188-90600 India 91-22-26836733 Israel 972-9-972-4400 Italy 39-02-24137-324 Japan 81-3-6430-2017 Korea 82-2-3404-3600 Lebanon 961-1-370-670 Luxembourg 32-2456-09-09 Malaysia 60-37-953-4800 Mexico 52-55-11-02-90-30 Netherlands 31-45-566-8800 Poland 48-22-4656900 Russian Fed. 7-495-580-73-77 Singapore 65-6776-6255 South Africa 27-11-466-1820 Spain 34-91-625-05-40 Taiwan 886-2-2183-6000 Thailand 662-232-7400 UK 44-1923-205-166 Alpha 2 MPO is a trademark of Medtronic, Inc. 2016, Medtronic, Inc. UC201600740aEN 01.2016