2021 Coding and Reimbursement Updates
Kim Cavitt, Au.D.
MEDICARE ALLOWABLE RATES
The 2021 Physician Fee Schedule Final Rule indicated an average 6 - 7% cut in allowable rate for all audiology services. Please consult your local Medicare fee schedule when available.
2021 TRADITIONAL MEDICARE BENEFICIARY DEDUCTIBLE
The 2021 traditional Medicare beneficiary deductible is $203.
CPT CODING CHANGES
There will be seven new CPT codes for audiology, effective January 1, 2021. Two audiology codes have been deleted.
These coding additions are:
- 92517: Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report, cervical (cVEMP)
- 92518: Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report, ocular (oVEMP)
- 92519: Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report, cervical (cVEMP) and ocular (oVEMP)
- 92650: Auditory evoked potentials; screening of auditory potential with broadband stimuli, automated analysis
- Replaces 92586.
- Used for pass/fail newborn and pediatric hearing screening.
- 92651: Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report
- Replaces 92585.
- Used for auditory evoked potential testing, used broadband stimuli, at a high and/or low intensity level to rule out conductive or sensorineural hearing losses and/or auditory neuropathy.
- 92652: Auditory evoked potentials; for threshold determination at multiple frequencies, with interpretation and report
- Replaces 92585.
- Used for a threshold search ABR.
- 92653: Auditory evoked potentials; neurodiagnostic, with interpretation and report
- Replaces 92585.
- Used for site of lesion testing.
These codes were deleted:
- 92585: Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive
- 92586: Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; limited
None of the new codes contain a TC/PC split. In other words, they do not have the capacity for the testing to be performed by a technician or an assistant and interpreted and reported by an audiologist or physician. The audiologist or physician must personally perform, interpret and report the procedures.
HCPCS CODING CHANGES
There are no significant HCPCS code changes that impact audiology in 2021.
ICD 10 CODING CHANGES
No significant ICD 10 coding changes went into effect on October 1, 2020.
EVALUATION AND MANAGEMENT CODING CHANGES
Code 99201 was deleted.
MEDICARE COVERAGE OF TELEHEALTH
92601-92604 are the only procedures Medicare covers via telehealth.
When providing telehealth services, you will need to either change your place of service code to 02 OR add the 95 modifier (synchronous telemedicine service rendered via a real-time audio and video telecommunications system). Please consult your payer guidance for which approach they recommend. Using the wrong approach can and will affect allowable rates.
MERIT BASED INCENTIVE PAYMENT SYSTEM (MIPS)
The MIPS requirements are unchanged for 2021. The low volume threshold remains as:
- Dollar Amount ($90,000) or
- Number of Beneficiaries (200) or
- Number of Covered Professional Services (200)
The nine audiology MIPS measures for 2021 are:
- Documentation of Current Medications in the Medical Record
- Preventive Care and Screening: Screening for Depression and Follow-Up Plan
- Falls: Risk Assessment
- Falls: Plan of Care
- Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness
- Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention
- Elder Maltreatment Screen and Follow-Up Plan
- Already a requirement of many state audiology licensure acts.
- Functional Outcome Assessment
- Falls: Screening for Future Falls Risk
MEDICARE COVERAGE OF TELEHEALTH
The Blue Cross Blue Shield Federal Employee Health Plan coverage of hearing aids for adults (over 21 years of age) is now eligible every five years rather than every three years.
Although there have been many anecdotal comments, we have received or viewed no written communications that indicate that members who purchased hearing aids in 2018, 2019, or 2020 will be eligible in three years rather than five years. This grandfather clause is NOT indicated in the plan documents. Please contact your local payer for confirmation.
THIRD-PARTY NETWORKS/PLANS
Many hearing aid benefits will become offered by or transitioned to third-party networks in 2021. Please make sure to verify all hearing aid benefits. Most benefits offered by third-party administrator plans have no out of network benefit. Please also review the third-party administrator process and pricing changes for 2021. Some are significantly changing in the new year.
For further questions, the Academy of Doctors of Audiology has a webinar that outlines these 2021 changes. Also, members may reach out to Kim Cavitt, Au.D. at
Dr. Kim Cavitt was a clinical audiologist and preceptor at The Ohio State University and Northwestern University for the first ten years of her career. Since 2001, Dr. Cavitt has operated her own Audiology consulting firm, Audiology Resources, Inc. She currently serves on the State of Illinois Speech Pathology and Audiology Licensure Board. She also serves on committees through AAA and ASHA and is an Adjunct Lecturer at Northwestern University.