Article - Billing and Coding: Vestibular and Audiologic Function Studies (A57434)

CMS National Coverage PolicySocial Security Act (Title XVIII) Standard References:Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.Article TextThis Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L35007 Vestibular and Audiologic Function Studies. Please refer to the LCD for reasonable and necessary requirements.Coding GuidanceNotice:It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.Consistent with the LCD, CPT codes 92553, 92557 and 92568 may be performed when there is current long-term use of ototoxic antibiotics.The professional component of the services represented by CPT codes 92537, 92538, 92541, 92542, 92544, 92545, 92546, 92587, 92588, 92651, 92652, and 92653 may be reported for services performed in inpatient, outpatient, nursing facilities (when Part A benefits have been exhausted), rehabilitation facilities, hearing and speech centers, independent clinics, and independent diagnostic testing facilities (IDTF).CPT codes 92547, 92552, 92553, 92555, 92556, 92562, 92563, 92565, 92571, 92572, 92575, 92576, 92577, 92582, 92583, and 92584 are considered technical services only codes and may be reported for services performed in the office setting, clinics, hearing and speech centers, and nursing facilities.Note:Payment for technical components of Technical Component (TC)/Professional Component (PC) services (when the PC is performed by an appropriate professional) and for technical-only services are allowed to hospitals.Utilization ParametersConsistent with the utilization outlined in the related LCD:CPT codes 92553, 92557, 92567 and 92568 may be reported once a month when a beneficiary is receiving ototoxic medicationsThe following may only be reported once during a session (same date of service)CPT codes 92541, 92542, 92544,92545 and 92546CPT code 92542 should not be billed two times for two positions or any multiple increments.Payment may be made for two of the following services per patient per year:CPT codes 92541, 92542, 92544, 92545 and 92546Documentation RequirementsAll documentation must be maintained in the patient's medical record and made available to the contractor upon request.Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.