In the era of COVID-19, it has become increasingly important to use different methods of clinical service provision to protect our patients’ health while still addressing their hearing, tinnitus, and vestibular health-care needs.
As audiology clinics increase their use of telehealth as a method for patient care, audiologists must understand how such changes also impact coding and billing. This article will discuss considerations and provide examples of billing and coding for telehealth services for audiologists.
Insurance coverage for telehealth services varies based on payer. It is unlikely that payers will cover a service delivered via telehealth if it was not already recognized as a covered service. In other words, non-covered services will remain non-covered if provided via telehealth. For specific or atypical situations, it is recommended that professionals contact the payer directly to obtain guidance on coding and billing for services provided via telehealth.
Telehealth Place-of-Service Codes and Modifiers
Health-care claim forms will typically have a space to indicate where the service took place. On the Centers for Medicare and Medicaid Services (CMS) 1500 health-care claim form, the place of service designation is reported in Box 24.b.
TABLE 1 provides the place-of-service designations most pertinent to audiologists.
- Place-of-service code 11—Office is primarily used for typical face-to-face procedures provided in audiology offices.
- Place-of-service code 02—Telehealth indicates that the services were provided through a telecommunication system.
|PLACE OF SERVICE||NAME||DESCRIPTION|
|Code 11||Office||Location, other than a hospital, skilled nursing facility, military facility, community health center, or state or local public health clinic where assessment, diagnosis, and treatment occurs on an ambulatory basis|
|Code 02||Telehealth||Location where services are provided through a telecommunication system|
Some payers may use modifiers to indicate services were provided via telehealth. The only modifiers applicable for audiology services are Modifiers -95 (Telehealth) and -GT (Telehealth).
On April 3, 2020, CMS provided guidance on appropriate reporting of telehealth services during the public health emergency (see Resources, CMS Guidance, Billing for Telehealth Services). Per CMS guidance, covered telehealth services should be reported using the appropriate procedure and diagnosis code(s), the normal in-person place of service (e.g., 11—Office), and the Modifier -95 to indicate the service was performed via telehealth. The Modifier -GT should only be reported if specifically instructed to do so by the payer.
|METHOD OF PATIENT INTERACTION||QUALIFYING CHARACTERISTICS||APPLICABLE PROCEDURE CODES (CHOOSE ONE)||ADDITIONAL CONSIDERATIONS|
|Nonphysician Telephone Services||
||98966 (5-10 min)
98967 (11-20 min)
98968 (21-30 min)
|Applicable ICD-10 Codes
Choose code(s) to describe the reason for the encounter.
Consider encounter codes (e.g., Z46.1, Z45.32, Z97.4).
Place of Service
11 – Office or other normal office location
|Nonphysician Online Digital Evaluation and Management (E/M) Services||
||98970/G2061* (5-10 min)
98971/G2062* (11-20 min)
98972/G2063* (21+ min)
|*G codes are exclusive to CMS; however, CMS does not cover G codes when provided by an audiologist; use the GY modifier. Other codes (i.e., 98970, 98971, 98972) are recommended for use among other payers.
**Practitioners are strongly encouraged to contact payers to determine whether reporting of these codes by audiologists is appropriate.
The CMS has approved the reporting of certain telehealth codes during the COVID-19 pandemic for certain practitioners who cannot bill Evaluation and Management (E/M) codes. These telehealth codes are presented in TABLE 2 (adapted from Resources, AMA). Readers should note that the codes provided in TABLE 2 may not be covered by Medicare or other payers when billed by audiologists. Audiologists are strongly encouraged to check with payer-specific guidance prior to reporting these codes.
Since covered audiology services through Medicare Part B are currently limited to diagnostic procedures, examples of telehealth services covered under Medicare for hearing and balance care are few. A list of audiology services covered through Medicare is provided elsewhere (see Resources, CMS Guidance, Audiology Code List). TABLE 3 presents the CPT codes that have been approved for telehealth provision as of May 1, 2020 (Academy, May 1, 2020).
For Medicare services that are never covered when provided by an audiologist, a voluntary ABN may be issued, but it is not required. More information regarding use of the ABN in audiology is provided in the Resources section (see Resources, Academy, ABN Quick Reference Guide). If the claim must be submitted to Medicare for denial, the GY or GY/GX modifier(s) would apply.
|CPT CODE||DESCRIPTION||ADDITIONAL CONSIDERATIONS|
|92601||Diagnostic analysis of CI, patient <7y, initial programming.||
If billing for procedures under non-facility rates, report regular in-person place of service (e.g., 11 – office) and Modifier -95
|92602||Diagnostic analysis of CI, patient <7y, subsequent reprogramming|
|92603||Diagnostic analysis of CI, patient ≥7y, initial programming|
|92604||Diagnostic analysis of CI, patient ≥7y, subsequent reprogramming|
Insurers Other than Medicare
Insurance coverage policies for Medicaid, CHIP, Medicare Advantage, and commercial insurance are discussed elsewhere (see Resources, Academy, COVID-19 Academy Resources). Practitioners are encouraged to seek telehealth coding and billing guidance directly from payers’ policy bulletins and websites. Clinicians should also reference payer-specific information when determining if a notice of non-coverage is necessary for services provided via telehealth.
Services Not Covered (Self-Pay)
Lack of coverage by insurers does not mean that audiologists cannot furnish services remotely or via telehealth as permitted through state licensure laws. As with other health care goods or services not covered by the payer, these services can be paid directly by the patient. If the service is not covered by a third-party payer, audiologists would apply policies and customary fees they would normally use for a similar face-to-face, self-pay transaction.
Considerations for Practitioners and Case Examples
A decision matrix for audiology telehealth services is presented in Figure 1. This tool outlines general considerations when billing patients for audiology telehealth services: (1) Would there typically be a charge for the service if provided in the office? (2) Would we typically be reimbursed for providing that service by a third-party payer? Or, would this charge be the patient’s responsibility? Below we will discuss three case examples pertaining to audiology services provided using telehealth.
Case Example 1
A long-standing patient was scheduled for a binaural hearing aid check (92593) prior to the public health emergency. The hearing aid check and reprogramming was conducted remotely using a telecommunications system. Hearing aid checks and related services are included in the purchase price of the hearing aids, meaning, there is typically no charge for this appointment.
Because the clinic does not charge a fee for this appointment, we would perform the procedure as usual, but would not bill the patient for the service.
Case Example 2
A patient was fitted with two hearing aids and was scheduled for a follow-up visit. Due to the public health emergency, they are unable to come into the office. Instead, the visit was conducted remotely and consisted of a binaural hearing aid check (92593). There is typically a fee for this service when provided in the office. The patient is a Medicare beneficiary without a secondary insurance.
Because there is a customary fee for this service when provided in office, we would also apply a fee for comparable services when provided via telehealth. Since the patient’s insurance, Medicare, does not include hearing aid services under covered services, we seek payment directly from the patient for the usual and customary fee of the 92593 service.
Case Example 3
An adult cochlear implant patient was seen for an initial programming session. Due to the public health emergency, the programming session was conducted by the audiologist via telehealth (synchronous audio and video) and use of remote programming software. There is typically a fee for this service when provided in a face-to-face transaction. The patient is a Medicare beneficiary.
Because there is a customary fee for this service when provided in office, we would also apply a fee for comparable services when provided via telehealth. Since the patient’s insurer, Medicare, covers cochlear implant programming codes when provided by audiologists via telehealth, we would choose the appropriate procedure code (here, 92603—Diagnostic Analysis of Cochlear Implant, 7 years and older, initial programming) and diagnosis code(s). We would then use the -11 Office place of service designation, and the Modifier -95 (Telehealth) to indicate that the service was provided remotely.
It is likely that the telehealth delivery model will remain even after the COVID-19 pandemic. As audiologists consider expanding their delivery model to include telehealth, there are many resources available for navigating coding and billing for these services. Updates and guidance from the Academy will be posted to the website.
We encourage members to contact the American Academy of Audiology’s Coding and Reimbursement Committee at [email protected] with questions regarding the provision of audiology services via telehealth.
*CPT codes, descriptions, and other data are Copyright 1966, 1970, 1973, 1977, 1981, 1983–2020 American Medical Association. All rights reserved. CPT© is a registered trademark of the American Medical Association.