SECTION 19 - PROCEDURE CODES 19.1 CPT CODES (TEXT DELETED 9/08)... 2 19.2 PARTICIPANT COPAY (TEXT DELETED 12/10)... 2 19.3 PROCEDURE CODES... 2 19.4 HCY PROCEDURE CODES FOR PARTICIPANTS 20 YEARS OLD AND UNDER... 14 1-11##2012
SECTION 19-PROCEDURE CODES Procedure codes used by Medicaid are identified as HCPCS codes (Health Care Procedure Coding System). The HCPCS is divided into three subsystems, referred to as level I, level II and level III. Level I is comprised of Current Procedural Terminology (CPT) codes that are used to identify medical services and procedures furnished by physicians and other health care professionals. Level II is comprised of the HCPCS National Level II codes that are used primarily to identify products, supplies and services not included in the CPT codes. Level III codes have been developed by Medicaid State agencies for use in specific programs. NOTE: Replacement of level III codes is required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Providers should reference bulletins for code replacement information. Reference materials regarding the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) may be obtained through the American Medical Association at: Order Department American Medical Association P.O. Box 930876 Atlanta, GA 31193-0876 Telephone Number: (800) 621-8335 AMA Members: (800) 262-3211 Fax Orders: (312) 464-5600 https://catalog.ama-assn.org/catalog/home.jsp 19.1 CPT CODES (text deleted 9/08) 19.2 PARTICIPANT COPAY (text deleted 12/10) 19.3 PROCEDURE CODES PROC CODE Exams DESCRIPTION 92557 Basic comprehensive audiometry hing exam, including the measuring of hing - 11##2012 AGE LIMIT REQUIRED ATTACHMENTS RHAE $20.00 REIMBURSEMENT AMOUNT 2
acuity and tests relating to air conduction, bone conduction, speech reception threshold, and speech discrimination. (The procedure must be ordered by a qualified physician and the diagnosis must be related to disease or trauma. Supporting documentation must be retained in the patient's file.) 9255722 Basic comprehensive audiometry hing exam, including the measuring of hing acuity and tests relating to air conduction, bone conduction, speech reception threshold, and speech discrimination (in a nursing home). (The procedure must be ordered by a qualified physician and the diagnosis must be related to disease or trauma. Supporting documentation must be retained in the patient's file.) 92620 Evaluation of central auditory function with report 1 st 60 minutes 92621 Evaluation of central auditory function with report each additional 15 minutes 92626 Evaluation of auditory rehabilitation status; first hour 92627 Evaluation of auditory rehabilitation status; add on 92630 Auditory rehabilitation; pre-lingual hing loss 92633 Auditory rehabilitation; post-lingual hing loss PA/RHAE $20.00 $21.51 $5.55 0-20 $40.88 0-20 $10.31 0-20 $10.50 0-20 $10.50 99429EP Unlisted preventive (hing) 0-20 $5.00 S9152 Speech therapy, re-evaluation $10.50 Hing Aids/Services V5011RT Fitting/orientation/checking of hing aid, $10.00 3-11##2012
V5011LT Fitting/orientation/checking of hing aid, V5011RT22 Post fitting evaluation, (used to bill for the post fitting evaluation). (Refer to Section 13.9.D(1) and Section 13.9.D(2) for special billing instructions.) V5011LT22 Post fitting evaluation, (used to bill for the post fitting evaluation). (Refer to Section 13.9.D(1) and Section 13.9.D(2) for special billing instructions.) V5030RT V5030LT V5040RT V5040LT Hing aid, monaural; body worn, air conduction, Hing aid, monaural; body worn, air conduction, Hing aid, monaural; body worn, bone conduction, Hing aid, monaural; body worn, bone conduction, $10.00 $25.00 $25.00 V5050RT Hing aid, monaural; in the, V5050LT Hing aid, monaural; in the, V5060RT Hing aid, monaural; behind the, right V5060LT Hing aid, monaural; behind the, V5090RT V5090LT Dispensing fee, unspecified hing aid, right (Refer to Section 13.9.C(1) for special billing instructions.) Dispensing fee, unspecified hing aid, left (Refer to Section 13.9.C(1) for special billing instructions.) PA/RHAE $95.00 PA/RHAE $95.00 V5100RT Hing aid, bilateral, body worn, V5100LT Hing aid, bilateral, body worn, V5110RT Dispensing fee, bilateral, PA/RHAE $95.00 V5110LT Dispensing fee, bilateral, PA/RHAE $95.00 4-11##2012
V5120RT Binaural; body, V5120LT Binaural; body. V5130RT Binaural; in the, V5130LT Binaural; in the, V5140RT Binaural; behind the, V5140LT Binaural; behind the, V5160RT Dispensing fee, binaural, PA/RHAE $95.00 V5160LT Dispensing fee, binaural, PA/RHAE $95.00 V5170RT Hing aid, CROS; in the, V5170LT Hing aid, CROS; in the, V5180RT Hing aid, CROS; behind the, V5180LT Hing aid, CROS; behind the, V5200RT Dispensing fee, CROS, PA/RHAE $95.00 V5200LT Dispensing fee, CROS, PA/RHAE $95.00 V5210RT Hing aid, bicros; in the, V5210LT Hing aid, bicros; in the, V5220RT Hing aid, bicros; behind the, V5220LT Hing aid, bicros; behind the, V5240RT Dispensing fee, bicros, PA/RHAE $95.00 V5240LT Dispensing fee, bicros, PA/RHAE $95.00 V5241RT V5241LT V5242RT V5242LT V5243RT Dispensing fee, monaural hing aid, any type, Dispensing fee, monaural hing aid, any type, Hing aid, analog, monaural, completely in the canal, Hing aid, analog, monaural, completely in the canal, Hing aid, analog, monaural, in the canal, PA/RHAE $95.00 PA/RHAE $95.00 5-11##2012
V5243LT V5244RT V5244LT Hing aid, analog, monaural, in the canal, Hing aid, digitally programmable analog, monaural, completely in the canal, right Hing aid, digitally programmable analog, monaural, completely in the canal, V5244RTEP Hing aid, digitally programmable analog, monaural, completely in the canal, right V5244LTEP Hing aid, digitally programmable analog, monaural, completely in the canal, V5245RT V5245LT Hing aid, digitally programmable analog, monaural, in the canal, Hing aid, digitally programmable analog, monaural, in the canal, V5245RTEP Hing aid, digitally programmable analog, monaural, in the canal, V5245LTEP Hing aid, digitally programmable analog, monaural, in the canal, V5246RT V5246LT Hing aid, digitally programmable analog, monaural, in the, Hing aid, digitally programmable analog, monaural, in the, V5246RTEP Hing aid, digitally programmable analog, monaural, in the, V5246LTEP Hing aid, digitally programmable analog, monaural, in the, 0-20(1) PA/RHAE/IofC 6-11##2012
V5247RT V5247LT Hing aid, digitally programmable analog, monaural, behind the, Hing aid, digitally programmable analog, monaural, behind the, V5247RTEP Hing aid, digitally programmable analog, monaural, behind the, V5247LTEP Hing aid, digitally programmable analog, monaural, behind the, V5248RT V5248LT V5249RT V5249LT V5250RT V5250LT Hing aid, analog, binaural, completely in the canal, Hing aid, analog, binaural, completely in the canal, Hing aid, analog, binaural, in the canal, Hing aid, analog, binaural, in the canal, Hing aid, digitally programmable analog, binaural, completely in the canal, Hing aid, digitally programmable analog, binaural, completely in the canal, V5250RTEP Hing aid, digitally programmable analog, binaural, completely in the canal, V5250LTEP Hing aid, digitally programmable analog, binaural, completely in the canal, V5251RT V5251LT Hing aid, digitally programmable analog, binaural, in the canal, Hing aid, digitally programmable analog, binaural, in the canal, RHAE/PA $385.00 RHAE/PA $385.00 0-20 RHAE 0-20 RHAE 7-11##2012
V5251RTEP Hing aid, digitally programmable analog, binaural, in the canal, V5251LTEP Hing aid, digitally programmable analog, binaural, in the canal, V5252RT V5252LT Hing aid, digitally programmable, binaural, in the, Hing aid, digitally programmable, binaural, in the, V5252RTEP Hing aid, digitally programmable, binaural, in the, V5252LTEP Hing aid, digitally programmable, binaural, in the, V5253RT V5253LT Hing aid, digitally programmable, binaural, behind the, Hing aid, digitally programmable, binaural, behind the, V5253RTEP Hing aid, digitally programmable, binaural, behind the, V5253LTEP Hing aid, digitally programmable, binaural, behind the, V5254RT Hing aid, digital, monaural, completely in the canal, 0-20 RHAE 0-20 RHAE V5254LT Hing aid, digital, monaural, completely in the canal, 8-11##2012
V5254RTEP Hing aid, digital, monaural, completely in the canal, V5254LTEP Hing aid, digital, monaural, completely in the canal, V5255RT V5255LT Hing aid, digital, monaural, in the canal, Hing aid, digital, monaural, in the canal, V5255RTEP Hing aid, digital, monaural, in the canal, V5255LTEP Hing aid, digital, monaural, in the canal, V5256RT V5256LT Hing aid, digital, monaural, in the, Hing aid, digital, monaural, in the, left V5256RTEP Hing aid, digital, monaural, in the, V5256LTEP Hing aid, digital, monaural, in the, left V5257RT V5257LT Hing aid, digital, binaural, behind the, Hing aid, digital, binaural, behind the, 9-11##2012
V5257RTEP Hing aid, digital, binaural, behind the, V5257LTEP Hing aid, digital, binaural, behind the, V5258RT V5258LT Hing aid, digital, binaural, completely in the canal, Hing aid, digital, binaural, completely in the canal, V5258RTEP Hing aid, digital, binaural, completely in the canal, V5258LTEP Hing aid, digital, binaural, completely in the canal, V5259RT V5259LT Hing aid, digital, binaural, in the canal, Hing aid, digital, binaural, in the canal, left V5259RTEP Hing aid, digital, binaural, in the canal, V5259LTEP Hing aid, digital, binaural, in the canal, left V5260RT V5260LT Hing aid, digital, binaural, in the, right Hing aid, digital, binaural, in the, left V5260RTEP Hing aid, digital, binaural, in the, right - 11##2012 10
V5260LTEP Hing aid, digital, binaural, in the, left V5261RT V5261LT Hing aid, digital, binaural, behind the, Hing aid, digital, binaural, behind the, V5261RTEP Hing aid, digital, binaural, behind the, V5261LTEP Hing aid, digital, binaural, behind the, V5264RT V5264LT Ear mold/insert, not disposable, any type, (a maximum of 4 may be billed on the same date of service) Ear mold/insert, not disposable, any type, left (a maximum of 4 may be billed on the same date of service) 0-20 RHAE 0-20 RHAE $25.00 $25.00 V5267 Hing aid supplies/accessories 0-20 V5275RT Ear impression, (a maximum of 4 may be billed on the same date of service) V5275LT Repairs L7510 L8615 L8616 Ear impression, (a maximum of 4 may be billed on the same date of service) Repair of prosthetic device, repair or replace minor parts Replacement headset/piece for cochl implant Replacement microphone for cochl implant $5.00 $5.00 11-11##2012
L8617 Replacement transmitting coil for cochl implant L8618 L8619 L8621 L8622 L8623 L8624 Replacement transmitter cable for cochl implant Cochl implant external speech processor, replacement Replacement zinc air battery for cochl implant each Alkaline battery for use with cochl implant, any size, replacement, each Lithium ion battery for use with cochl implant device speech processor; other than level, replacement each Lithium ion battery for use with cochl implant device speech processor; level, replacement each V5014RT22 Repair to hing aids which are not covered by the one y warranty. V5014LT22 Repair to hing aids which are not covered by the one y warranty. V5014RT V5014LT Repair/modification of a hing aid (no longer under warranty) Repair/modification of a hing aid (no longer under warranty) Special Otorhinolaryngologic Services 92507 Treatment of speech, language, voice, communication, and/or auditory disorder includes aural rehabilitation; individual. Maximum quantity per day is 16 units. (A unit is up to 15 minutes.) 92601 Diagnostic analysis of cochl implant, patient under 7 ys of age; with programming. Maximum quantity per day is 16 units. (A unit is up to 15 minutes.) - 11##2012 $10.50 $10.50 12
92602 Diagnostic analysis of cochl implant, patient under 7 ys of age; subsequent reprogramming. Maximum quantity per day is 16 units. (A unit is up to 15 minutes.) Do not report in addition to 92601 on the same date of service 92603 Diagnostic analysis of cochl implant, patient 7 ys or older; with programming. Maximum quantity per day is 16 units. (A unit is up to 15 minutes.) 92604 Diagnostic analysis of cochl implant, patient 7 ys or older; subsequent reprogramming. Maximum quantity per day is 16 units. (A unit is up to 15 minutes.) Do not report 92604 in addition to 92603 on the same date of service. $10.50 $10.50 $10.50 Special Tests (Covered Only When Prescribed by a Physician) The physician must indicate in Section "B" on the RHAE form, why the tests are being ordered. 92562 Loudness balance test, alternate binaural or monaural (retrocochl vs. cochl) $3.30 92563 Tone Decay Test $3.30 92564 Short Increment Sensitivity Index (SISI) $3.30 92567 Tympanometry (impedance testing) $5.00 92568 Acoustic Reflex Testing $5.00 Healthy Children and Youth (HCY) For Participants 20 and Under Only V5266 Battery for use in hing device (When billing for batteries, list the number of batteries dispensed in Field #24 of the CMS - 1500 claim form.) 0-20 $1.56 V5298RT Hing aid, not otherwise classified, 0-20 V5298LT Hing aid, not otherwise classified, 0-20 13-11##2012
V5299 Hing service, miscellaneous (Includes FM Systems, noncovered testing, repair to hing equipment other than hing aids, etc. Not to be used for hing aids.) 0-20 RHAE, Report of Hing Aid Evaluation; PA, Prior Authorization;, Manually priced; MNF, Certificate of Medical Necessity maintained in the provider's file # A copy of the completed RHAE form must be attached to the claim if it is the only procedure being billed for all participants age 21 and over. (1) Not covered for participants under the age of 13 except for medically necessary reasons, e.g., no external, psychological reasons, etc. 19.4 HCY PROCEDURE CODES FOR PARTICIPANTS 20 YEARS OLD AND UNDER Many of the HCY procedure codes require a Certificate of Medical Necessity form. Reference Section 7, Medical Necessity, for a sample Certificate of Medical Necessity form. PROC DESCRIPTION CODE 92506 Evaluation of speech, language, voice communication, auditory processing and/or aural rehabilitation status. Maximum quantity per day is 16 units (A unit is up to 15 minutes.) AGE REQUIRED LIMIT ATTACHMENTS 0-20 REIMBURSEMENT AMOUNT $10.50 92531 Spontaneous nystagmus, including gaze 0-20 MNF $18.85 92532 Positional nystagmus 0-20 MNF $21.90 92533 Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests) 0-20 MNF $24.45 92534 Optokinetic nystagmus 0-20 MNF $27.10 92541 Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording 92542 Positional nystagmus test, minimum of 4 positions, with recording 92543 Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests), with recording 0-20 MNF $20.00 0-20 MNF $20.00 0-20 MNF $23.28 14-11##2012
92544 Optokinetic nystagmus test, bidirectional foveal or peripheral stimulation, with recording 0-20 MNF $10.00 92545 Oscillating tracking test, with recording 0-20 MNF $10.00 92546 Sinusoidal vertical axis rotational testing 0-20 MNF $15.00 92547 Use of vertical electrodes in any or all of above tests counts as one additional test 0-20 MNF $5.11 92551 Screening test, pure tone, air only 0-20 $5.00 92552 Pure tone audiometry (threshold); air only 0-20 $8.00 92553 Pure tone audiometry (threshold); air and bone 0-20 $11.00 92555 Speech audiometry threshold 0-20 $5.00 92556 Speech audiometry threshold; with speech recognition 0-20 $5.00 92565 Stenger test, pure tone 0-20 $10.76 92572 Staggered spondaic word test 0-20 $14.25 92577 Stenger test, speech 0-20 $14.83 92579 Visual reinforcement audiometry (VRA) 0-20 $20.00 92582 Conditioning play audiometry 0-20 $20.00 92583 Select picture audiometry 0-20 $5.00 92584 Electrocochleography 0-20 PA $57.20 92585 Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive 92586 Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; limited. 92587 Evoked otoacoustic emissions; limited (single stimulus level, either transient or distortion products) 0-20 $85.32 0-20 $35.43 0-20 $27.11 15-11##2012
92588 Evoked otoacoustic emissions; comprehensive or diagnostic evaluation (comparison of transient and/or distortion product otoacoustic emissions at multiple levels and frequencies) 0-20 $38.08 RHAE, Report of Hing Aid Evaluation; PA, Prior Authorization;, Manually priced; MN, Certificate of Medical Necessity; MNF, Certificate of Medical Necessity maintained in the provider's file Copay required END OF SECTION TOP OF PAGE 16-11##2012