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2015 Hospital Outpatient Prospective Payment System (HOPPS)

2015 Hospital Outpatient Prospective Payment System (HOPPS)

Effective January 1, 2015, The Centers for Medicare and Medicaid Services (CMS) reclassified several Ambulatory Payment Classification (APC) categories, which will affect payment of audiology services performed in hospital outpatient departments. APCs are grouped by payment methodology, which often places audiology services with non-audiology services in the same APC and paid at the same rate.
The following CPT codes are classified in APCs 0216 and 0218. If billed on the same date of service as those in APC 0364, they will not be reimbursed separately:
92586 (auditory evoked potentials, limited)
92585 (auditory evoked potentials, comprehensive)
92507-95913 (Nerve conduction studies)
92584 (electrocochleography)

This table illustrates APC 0363, otorhinolaryngologic and related tests category.  Considered primary, these will be reimbursed at the rate assigned to this APC. If additional tests classified in APC 0364 and/or 0365 are performed on the same date of service as those in 0363, tests in APC 0364 and/or 0365 will be packaged with the primary APC 0363 and will not be reimbursed separately. Non-audiology services such as radiographic studies are also considered primary and if done on the same date of service as those in APC 0364 and/or 0365, the tests in APC 0364 and/or 0365 will be packaged with that primary service.

Example: If I perform CPT code 92587 (Distortion Product OAEs, limited 3-6 frequencies or TEOAEs, with interp and report), a primary code, on the same date of service with CPT code 92557 (Comprehensive audiometry threshold evaluation and speech recognition), CPT code 92587 will be reimbursed at the APC 0363 rate and 92557 will not be reimbursed separately.

CPT Code

Service

92516

Facial nerve function studies (e.g., electroneuronography)

92540

Basic vestibular evaluation

92543

Caloric vestibular test, ea. irrigation (binaural, bithermal)

92544

Optokinetic nystagmus test, bidirectional, foveal or peripheral stim, w/recording

92545

Oscillating tracking test, with recording

92546

Sinusoidal vertical axis rotational testing

92548

Computerized dynamic posturography

92587

Distortion Product OAEs, limited 3-6 frequencies or TEOAEs, with interp and report

92588

Comprehensive diagnostic evaluation, minimum of 12 frequencies, with interp and report

 

This table includes the APC 0364, Level I Audiometry codes. If additional tests classified in APC 0364 and/or  0365 are performed on the same date of service as those in APC 0363, tests in APC 0364 and/or 0365 will be packaged with the primary APC 0363 and will not be reimbursed separately.

CPT Code

Service

92555

Speech audiometry threshold

92556

With speech recognition

92563

Tone decay test

92564

Short increment sensitivity index (SISI)

92565

Stenger test, pure tone

92567

Tympanometry (impedance testing)

92571

Filtered speech test

92575

Sensorineural acuity level test

92576

Synthetic sentence identification test

92596

Ear protector attenuation measurements

 

This table includes the APC 0365, Level II Audiometry. If additional tests classified in APC 0364 and/or 0365 are performed on the same date of service as those in APC 0363, tests in APC 0364 and/or  0365 will be packaged with the primary APC 0363 and will not be reimbursed separately.

CPT Code

Service

92550

Tympanometry and reflex threshold measurements

92552

Pure tone audiometry (threshold); air only

92553

Pure tone audiometry; air and bone

92557

Comprehensive audiometry threshold evaluation and speech recognition

92579

Visual reinforcement audiometry

92582

Conditioning play audiometry

92601

Diagnostic analysis of CI, patient younger than 7 years of age, with programming

92602

Subsequent reprogramming

92603

Diagnostic analysis of CI, age  7 years or older, with programming

92604

Subsequent reprogramming

92620

Evaluation of central auditory function, with report, initial 60 minutes

92625

Assessment of tinnitus (includes pitch, loudness matching and masking)

92626

Eval of auditory rehabilitation status, first hour

92640

Diagnostic analysis with programming of auditory brainstem implant, first hour

CPT® codes and descriptions are copyright 2015 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association (AMA).

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