What is the accepted definition of what is included in a Hearing aid examination and selection (92590) and a Hearing aid check (92592)? Should an earmold impression (V5275) be included if done in one of the above or billed separately?
To my knowledge, there is not a strict guideline for these codes in contrast to other diagnostic CPT codes. Adding to this is the change in technology and philosophy associated with hearing aid selection and fitting procedures. When these codes were developed, there was a wide variety of selection philosophies for hearing aid selection. Some clinicians still abided by the Carhart guidelines of selecting multiple hearing aids and evaluating performance, others selected only one hearing aid and made adjustments to the frequency response and output. With the advent of digital hearing aids, the fitting philosophies have changed even more to focus on one hearing aid, completing electronic programming of the gain, frequency response, and output characteristics. If the hearing aid as multiple channel selections, then those are included into the programming algorithm. Several instruments have the ability to perform feedback measurements to verify in situ what the clinician has done. A hearing aid check also has many different procedures and philosophies depending on the type of hearing aid fitted, the age of the individual, etc. It may include reviewing a use diary, listening to patient feedback, performing ear canal probe microphone measurements, or in some cases performing sound field detection or discrimination measurements. In part, the reason why these codes are so variable is because very few third party payers offer reimbursement. But, that is clearly not the only reason. This is an instance where one code can represent many correct ways of getting the job done. Indeed, technology and changes in the state of the art combined with our knowledge of cochlear function have greatly influenced what we do with regard to hearing aids. The only guidance I would offer is to use 92590 / 92591 only when selecting and fitting a new hearing aid for monaural and binaural situations, respectively. A hearing aid check should be justifiable by what happens during the contact. I would offer that simply talking with a patient/client for five minutes to determine how things are going does not constitute a hearing aid check. Actually performing some type of measurement, whether 2 cc coupler analysis, probe microphone measurements, or some type of sound field evaluation, the clinician must be actively involved with the patient/client in order to justify any charge that proceeds from the visit. Whatever is done, however, should be carefully documented. It doesn't matter whether one deals with a third party payer or not, all contacts should be documented to record what transpired for each contact. This is as much for the clinician's protection as it is for any billing purposes.
And as for the last question, in my experience, earmold impressions typically do not carry a charge. The cost of the impression material and the amount of time spent doing the impression is most often wrapped up on the price of the earmold when the product is delivered to the patient/client. It is not part of the hearing aid selection procedure (e.g., the impression to make an earmold). The earmold itself can be billed separately from the hearing aid and from the hearing aid selection code as an itemized cost. In fact, some states require it. But keep in mind, the code listed in the question is a HCPCS code used primarily for Medicaid billing. If dealing with a third party payer, be sure to check with that payer first to find out which code the payer prefers each audiologist to use. If the payer states that the HCPCS code is required, then by all means use that code. If the payer uses the CPT system, then code 92700 (unlisted procedure) would be the appropriate code and would require an itemization of the earmold to justify the cost.
Robert C. Fifer, Ph.D.
Director of Audiology and Speech-Language Pathology
University of Miami
Mailman Center for Child Development