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Use of CPT Code 92507 and TOS Codes

Debbie Abel, AuD

June 6, 2005


Question

Part A:
I have had difficulty with the code 92507, which I thought was to be used when hearing treatment/feedback/counseling was done. Is there a different code I should be using in lieu of this? Some insurance companies will not cover this CPT code?

Part B:
Are TOS (Type of Service) codes required when billing Medicare for audiological function tests?

Answer

Part A:
92507 is considered a treatment code and Medicare and some other third party payers will not reimburse audiologists for treatment codes. Depending on how it is to be used (hearing aid? tinnitus?) may determine a code other than the dreaded 92700 which yields low reimbursement for a substantial amount of clinical work and time. For example if it is used with a hearing aid fitting, you could use a HCPCS code of V5011 (Fitting/orientation/checking of a hearing aid) although V5090 (dispensing fee, unspecified hearing aid) or V5110 (Dispensing fee, bilateral) are other choices if accepted by those third party payers with whom you contract. Contacting those third party payers to see the codes they will accept may reduce the time in awaiting payment. For a hearing aid recheck, the HCPCS code of V5020 for a conformity evaluation may be appropriate and reimbursable. If billing this code, the visit needs to include some type of performance measurement to assess hearing aid function.

Part B:
I believe that TOS applies to hospice, ambulatory surgery centers and drugs. Except for the possibility of ototoxicity monitoring in a hospice setting, audiological services would likely be billed Part A if it is a hospital based hospice or Part B if provided as an outpatient service

Debra Abel, Au.D., Chair of the Coding and Practice Management Committee for the American Academy of Audiology. Also sits on the Ethical Practices Board of AAA, is the Chair of the Ohio Board of Speech-Language Pathology and Audiology and in private practice for over 12 years in Alliance, OH. She can be reached at audiology@neo.rr.com


debbie abel

Debbie Abel, AuD


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