New Audiology CPT Category III Codes

January 27, 2010 - There are five new Current Procedural Terminology (CPT^[1]) Category III codes [PDF] related to audiometry that became effective on January 1, 2010. Audiologists routinely report CPT codes for billing clinical services, but the CPT codes audiologists know the best are Category I codes. These codes, such as 92557, must meet the following CPT Category I requirements:

• Services or procedures are performed by many health care professionals across the country
  
  
• FDA approval is documented or imminent with a given CPT cycle
  
  
• The service or procedure has a proven clinical efficacy
  
  
• The service or procedure has relevance for research, either ongoing or planned

In contrast, Category III codes are "a set of temporary codes for emerging technology, services, and procedures" assigned an alphanumeric identifier with a letter in the last character. The five new audiometric codes are not in the 2010 CPT Codebook but became effective on January 1, 2010. They are:

• 0208T Pure tone audiometry (threshold), automated;air only
  
• 0209T air and bone
  
• 0210T Speech audiometry threshold, automated;
  
• 0211T with speech recognition
  
• 0212T Comprehensive audiometry threshold evaluation and speech recognition (0209T, 0211T combined), automated

In a follow-up rationale to the American Medical Association (AMA), automated was distinguished from computer assisted. Audiologists use many computer assisted devices for procedures such as otoacoustic emissions and evoked potentials. The use of these devices requires the constant presence and vigilance of the audiologist to ensure appropriate data gathering for test interpretation. In contrast, automated refers to equipment intended to be used without ongoing monitoring and vigilance whereby the equipment follows a specified algorithm to determine what action to take next.

Audiologists should report these new Category III codes when automated audiometry is performed. Of course, for manual audiometric testing by an audiologist or physician, 92551-92557 should be used. Bekesy audiometry codes 92560 and 92561 are also available when appropriate. According to the AMA, the "assignment of a CPT Category III code to a service does not indicate that it is experimental or of limited utility, but only that the service or technology is new and is being tracked for data collection." The AMA points out that, "in the Final Rule for the 2002 Medicare Physician Fee Schedule (Federal Register, Thursday, November 1, 2001), the Centers for Medicare and Medicaid Services (CMS) stated that they believed that Category III codes 'will serve a useful purpose' and that payment for the service is at the discretion of the Carriers, but that the codes could be paid after entered into the computer systems."

Please contact reimbursement@asha.org with questions or comments.

^[1] CPT is a registered trademark of the American Medical Association

Taken from www.asha.org/News/.