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2023 ADA Coding and Reimbursement Update

Presentation Date: 12/11/2023
CE Expiration Date: 12/11/2024

Return to: Webinars

Duration: 1:53:58

The 2024 Coding and Reimbursement Update Webinar, presented by Dr. Kim Cavitt, offers a detailed, advanced overview of changes to audiology coding, reimbursement policies, and compliance guidelines effective January 1, 2024. Dr. Cavitt, a seasoned audiologist and consultant, began by emphasizing that this was an advanced session focused on new developments rather than foundational concepts. She introduced two new CPT codes (92622 and 92623) for programming auditory osseointegrated devices, distinguishing these from evaluation codes (92626 and 92627), and highlighted documentation requirements, including time tracking and billing units.

She covered the critical use of code 92700 for procedures lacking a specific CPT designation and explained documentation and billing nuances, such as submitting claims with physician orders, using notices of non-coverage, and collecting usual and customary fees when services are not covered. She gave examples of procedures that may require 92700, including speech-in-noise testing, vestibular assessments, and device selection services beyond basic evaluation.

Dr. Cavitt also discussed Evaluation and Management (E/M) coding for audiologists, stressing state-specific scope-of-practice limitations. She advised practitioners to obtain written verification from their state boards or legal counsel before billing E/M codes, as improper billing can result in denied claims, malpractice risks, and potential liability. She described E/M coding changes, like updated minimum time requirements, and advised against using higher-level codes without meeting complexity standards.

She reviewed modifier usage, clarifying when to use 59, XE, XS, and XU modifiers to denote distinct procedural services, and underscored the importance of not charging for items received at no cost. She elaborated on unlisted hearing aid service code V5299, stressing proper line-item billing and use of notices of non-coverage for items like extended warranties, FM fitting, or syncing devices.

The presentation addressed regulatory changes from the FDA, distinguishing between the Over-The-Counter (OTC) and Prescription Hearing Aid Classes. Dr. Cavitt warned that despite relaxed federal requirements, state laws may still impose stricter mandates, particularly around pediatric medical clearance. She explained that prescription hearing aids now require legal authority to prescribe, documentation, and awareness of insurance policies that might deny claims without valid prescriptions.

She encouraged audiologists to join and support their state audiology associations for lobbying and scope-of-practice advocacy. On the topic of third-party coverage, she stressed that insurers only reimburse medically necessary services and recommended that providers document the clinical rationale for hearing aid recommendations and features.

Dr. Cavitt provided a thorough breakdown of insurance types—including traditional Medicare, Medicare Advantage, Medicaid, commercial plans, and dual eligibility plans—explaining coverage policies, billing practices, limitations, and best practices. She advised using portals like Availity to verify real-time eligibility and emphasized the use of AB modifiers for Medicare-covered services without physician orders, noting that these can only be used once per year per beneficiary.

Finally, she discussed the Merit-based Incentive Payment System (MIPS) and explained when audiologists must report, how to verify eligibility, and the importance of using registries for consistent, compliant quality reporting. She closed by advising practices to weigh the pros and cons of insurance participation and consider establishing separate legal business entities if they want to manage both in- and out-of-network services strategically.

Overall, the presentation served as an exhaustive guide for audiologists navigating the complex 2024 landscape of coding, reimbursement, compliance, and healthcare policy.


Speaker(s):
  • Kim Cavitt, Au.D., Audiology Resources, Inc