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New Vestibular Caloric Testing Codes and Payment Rates for 2016

New Vestibular Caloric Testing Codes and Payment Rates for 2016

In late 2014, the American Academy of Audiology and the American-Speech-Language-Hearing Association (ASHA) worked in collaboration with the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the American Academy of Neurology (AAN) to survey two new Current Procedural Terminology (CPT) codes to describe vestibular caloric testing. These two new CPT codes, 92537 and 92538, will replace CPT code 92543 (Caloric vestibular test, each irrigation, with recording) beginning in 2016. A description of the new codes is as follows:

  • CPT code 92537, Caloric vestibular test with recording, bilateral; bithermal (i.e., one warm and one cool irrigation in each ear for a total of four irrigations)
  • CPT code 92538, Caloric vestibular test with recording, bilateral; monothermal (i.e., one irrigation in each ear for a total of two irrigations)

The purpose of these surveys was to assess and revise the "professional work" value for each procedure. Professional work value includes factors such as mental effort and judgment, technical skill, and psychological stress. This is part of the valuation process established by the American Medical Association's Relative Value Update Committee (RUC).  During this rigorous process, representatives from the specialties listed above worked to develop the new code descriptors, survey the respective memberships of each involved specialty, prepare solid recommendations based on the survey results, and present this information to the RUC for consideration. The RUC agreed with our proposed values and made a recommendation to CMS to accept these values. Despite solid survey data, a cogent presentation before the RUC, advocacy efforts on behalf of the Academy and other stakeholders, and the support of the RUC itself, CMS opted not to accept the RUC recommended values for the new caloric codes 92537 and 92538.

Overall, these new vestibular caloric testing codes will have lower reimbursement rates for CY 2016 than when these services were defined under CPT code 92543 in CY 2015. The changes are detailed in the chart below. The Academy continues to advocate for fair reimbursement for audiology services and will continue to challenge CMS on their decision to not accept the RUC recommended values for the vestibular caloric testing codes.

Estimated Payment Rates for New Caloric Codes in 2016

CPT Code

Description

CY 2015
Work RVU

CY 2015 PE RVU

CY 2016
Work RVU

CY 2016
PE RVU

CY 2015
Payment Rate

CY 2016
Payment Rate

(New) 92537

Caloric vestibular test with recording, bilateral; bithermal

NA

NA

.60

.51

NA

$40.84

(New) 92538

Caloric vestibular test with recording, bilateral; monothermal

NA

NA

.30

.27

NA

$20.78

92543*

Caloric  Vestibular Test

.10

.33

NA

NA

$16.11

NA

 

*New CPT codes 92537 and 92538 will replace CPT code 92543 in 2016.

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