Medicare still won’t reimburse audiologist-billed Epley.
After two years of battles with CMS over canalith repositioning procedure (CRP) coding, physicians will finally get paid for these specific codes.
CPT® 2009 excited ENT coders with new CPT code 95992 (Canalith repositioning procedure[s] [e.g., Epley maneuver, Semont maneuver], per day) . The 2009 Medicare Physician Fee Schedule cut coders’ applause short. CMS assigned the codes ‘B’ status or always bundled making payment for CRP or the Epley menauever using the new code impossible to obtain.
The 2011 Medicare Physician Fee Schedule ends the fight for payment of CRP. At the beginning of next year, the codes status will be “A’”, announced Marc Hartstein, deputy director, hospital and ambulatory policy group, Center for Medicare, at the CPT and RBRVS 2011 Annual Symposium. “We will finalize the proposal with a work RVU of 0.75 and the RUC recommended PE inputs.”
When 95992 had status B, ENTs were instructed to instead use an E/M code. Now, they’ll be able to specifically code for the work of CRP with 95992.
Remember: If the ENT performs and documents a medically necessary E/M that is significant and separately identifiable from the CRP, append modifier 25 to the E/M service. In addition, Medicare does not allow payment for audiologists performing therapeutic procedures, such as CRP.
Get more CPT 2011 ENT updates with the “2011 Otolaryngology Coding Update” by Jen Godreau, BA, CPC, CPMA, CPEDC.