Abel’s Coding Advice
It’s not too early to think about coding and insurance changes for 2020. Here are some things to consider as you plan for next year.
The Medicare Physician Fee Schedule proposed rule was released on July 29, 2019, detailing the following for 2020 implementation:
- The low volume threshold for reporting on Merit-Incentive Payment System measures remains the same for reporting and does not apply to the clear majority of audiologists. You are likely not required to report if you are:
- Paid $90,000 or more by Medicare AND
- Saw 200 or more Medicare beneficiaries AND
- Provided 200 or more Medicare covered services
- If you bill less than the above, you are not required to report; however, it is strongly recommended you ensure your eligibility and the need to report here.
- You may choose to report voluntarily, and the measures on which audiologists may report are the same as they were with the Physician Quality Reporting System (PQRS) with an additional three new measures for 2020 (indicated with an asterisk):
- Measure 130: Documentation of Current Medications in the Medical Record
- Measure 134: Preventive Care and Screening: Screening for Depression and Follow-Up Plan
- Measure 154: Falls: Risk Assessment
- Measure 155: Falls: Plan of Care
- *Measure 181: Elder Maltreatment Screen and Follow-Up Plan
- *Measure 182: Functional Outcome Assessment
- Measure 226: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
- Measure 261: Referral for Otologic Evaluation for Patients With Acute or Chronic Dizziness
- *Measure 318: Falls: Screening for Future Falls Risk
- Specialty sets will be rolled out for several professions, including audiology
- CPT© code 92626 will have a new descriptor, “evaluation of auditory function for surgically implanted device(s) candidacy or post-operative status of a surgically implanted device(s); first hour.” The RVUs will not change, so the Medicare payment will be essentially the same as the payments were in 2019. The conversion factor will increase from $36.04 in 2019 to $36.09, resulting in a very minimal increase, if any, to Medicare Part B payments.
- CPT© code 92627 does not change and remains as the add-on code for each additional 15 minutes of the evaluation.
- CPT© code 92548 also has a new descriptor, “computerized dynamic posturography sensory organization test (CDP-SOT), six conditions (i.e., eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report.”
- A new CPT© code will be available to report when the MCT (motor control test) and ADT (adaption test) are completed with the SOT (sensory organization test). Given that the Centers for Medicare and Medicaid did not accept the recommended values, it is likely that the values for both 92548 and the new code will be lower.
- Effective January 1, 2020, Part B Medicare claims must be submitted with the new Medicare Beneficiary Identifier (MBI) and not the patient’s Social Security Number.
Finally, there will be a new marriage in the world of insurance: EPIC Hearing Healthcare and hi HealthInnovations® are merging and will be known as UnitedHealthcare Hearing in 2020. Until December 31, 2019, these two companies will continue to operate independently.