Category Archives: Helpful Information

Female audiologist with female patient

Medicare Updates and Audiology Changes for 2024

New Bone Anchored Codes and Payment Adjustments

Key Takeaways:

  • Starting January 1, 2024, audiologists will be able to bill for diagnostic analysis, programming, and verification of auditory osseointegrated devices (92622 & 92623)
  • The codes are timed codes with 92622 representing the first hour of service and 92623 serving as additional 15-minute increments
  • The CMS has lowered their conversion factor to $32.74, making the reimbursement for 92622 & 92623 $77.59* and $19.97* respectively

 The Centers for Medicare & Medicaid Services (CMS) has proposed significant changes for audiology services in 2024. Audiologists will see the introduction of two new timed codes effective January 1, 2024, which describe the analysis, programming, and verification of an auditory osseointegrated sound processor like the Ponto bone anchored hearing system (BAHS). Additionally, the CMS has proposed payment adjustments and continued telehealth coverage. Let’s dive into the details.

New Auditory Osseointegrated Device (AOD) Services Codes

Starting from January 1, 2024, audiologists will be able to use two new CPT codes for Auditory Osseointegrated Device (AOD) services. These codes are designed to cover the diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor:

  • 92622: Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; first 60 minutes.
  • 92623: Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; each additional 15 minutes (use 92623 in conjunction with 92622).

A keynote is that these codes are applicable to audiologists without a physician’s referral for a non-acute hearing condition. Furthermore, they include tasks such as attachment of the processor, device feedback calibration, device programming, and verification of processor performance for various types of auditory osseointegrated sound processors.

Important Points about AOD Services

  • Timed Codes: The new codes, 92622 and 92623, are timed codes that describe the first hour and each subsequent 15 minutes of time spent on the analysis, programming, and verification of an auditory osseointegrated sound processor.

If an evaluation lasts less than 30-minutes, 92623 (code indicating additional 15 minutes) should not be billed independently from 92622. Additionally, the -52 modifier should also not be used with 92622 or 92623 in this case. Instead, 92700 (unlisted Otorhinolaryngological Service or Procedures) can be used with the proper documentation and justification.

  • Reprogramming: These codes may also be used for reporting subsequent reprogramming of AODs.
  • Restrictions: Notably, CPT codes 92626 and 92627 may not be reported in conjunction with 92622 and 92623.

Medicare Physician Fee Schedule (PFS) Changes and Reimbursement

CMS has adjusted the Medicare Physician Fee Schedule (PFS) for the calendar year 2024. Key highlights include an overall payment rate reduction of 1.25 percent in calendar year (CY) 2024 compared to CY 2023. The final CY 2024 PFS conversion factor is $32.74, representing a decrease of $1.15 (or 3.4 percent) from the CY 2023 conversion factor of $33.89.

*According to the American Academy of Audiology, the “CY 2024 Final Payment” for non-facilities for the new service codes will be as follows. Note final reimbursement is dependent on your locality:

  • 92622 –  $77.59
  • 92623 – $19.97

Click the links below for more information regarding these important changes:

Microsoft Word – Audiology MPFS Final CY 2024.Table.docx

Medicare Proposes New Codes and Reporting Measures, Payment Cuts, and Continued Telehealth Coverage for 2024 (asha.org)

Calendar Year (CY) 2024 Medicare Physician Fee Schedule Proposed Rule | CMS

Medicare Finalizes CY 2024 Payment Rules – American Academy of Audiology

*Content updated 3/26/24

Insurance and Bone Anchored Hearing Systems

Your Frequently Asked Questions, Answered

If you are a practicing audiologist, chances are that you spend some time each week working on billing and reimbursement. Patients want to know what is covered;  you want to get paid for your services and run a profitable business. Audiologists are challenged with maintaining an understanding of billing and coding in an ever-changing healthcare landscape while treating patients using best practices. Your patients rely on you to give them the best service while also maximizing their health insurance benefits.

We know that the billing and reimbursement process can be daunting for busy clinicians. For this blog, we invited Oticon Medical’s Insurance Services Specialist, Brianna Rusay, to answer your most frequently asked questions about reimbursement as they pertain to bone anchored hearing systems (BAHS).

I am new to bone anchored hearing systems. What does my clinic need to prepare for ordering a device for a patient?

Your patient considering a bone anchored device will need to have up-to-date audiological and medical records as they pertain to their hearing loss and diagnosis. They should have a current audiogram performed by a licensed audiologist within the last year and a full medical evaluation by their physician, especially if they are considering surgery. Your patient’s current insurance information should be on file and your office should verify that your practice is in network with their insurance company if you plan to use your patient’s health benefits when ordering the device. You should be prepared to write a letter on your patient’s behalf justifying your choice of bone anchored hearing device as treatment for their hearing loss, and all documentation supporting your choice should be readily available. Finally, your clinic should have an established account with Oticon Medical to proceed with ordering one of our devices for a patient. You can contact your region’s Oticon Medical Clinical Specialist to set up an account with us.

Who looks into the patient’s benefits to see if they have coverage for surgery?

Surgical coverage will depend on both the surgeon and the hospital/surgical center where the surgery is performed. Oticon Medical has a team of insurance specialists who can check benefits and authorization requirements for BAHS surgery, or the hospital/surgical center can request the authorization directly.

Will my clinic be responsible for paying for the surgical supplies? What about the processor?

Reimbursement for the surgery is fully covered with two codes: 69714 and L8690. 69714 is for the BAHS procedure itself and both the facility and the surgeon can bill for this code. L8690 includes the sound processor, abutment, and implant. This code is considered Durable Medical Equipment (DME) and is typically billed by the facility. A DME contract with the insurance company must be in place in order to bill on this code.

What CPT code will I bill for the processor fitting?

Currently, there is no reimbursable code for a BAHS fitting. However, some insurance companies allow the miscellaneous code 92700 to be used for the sound processor fitting. When billing with this code, be sure to include detailed notes about what services will be included for this code and the breakdown of cost.

How will I get paid for my services?

If the insurance company allows it, you may use the miscellaneous 92700 code.  If the insurance company does not cover that code, the patient would be responsible for all fitting costs. Some clinics have chosen to bill the patient a fitting fee for their time spent in fitting the bone anchored sound processor. This fee can vary and can be up to the discretion of the clinic’s billing administrators.

What happens when it is time to upgrade the processor?

Oticon Medical will start the process of upgrades through insurance for your patient. Please refer your patient to our Insurance Services department and we will send them the paperwork to begin processing the request. To process an upgrade request, we will need the following:

  • Two completed intake forms (one from the patient and one from the clinic)
  • A signed prescription for the ordered upgrade (must be signed by a physician)
  • An audiogram (should be within the last year)
  • Medical notes (should be within the last year)

What if the patient is not eligible for surgery?

Many plans still have coverage for BAHS when worn on a softband, though Medicare does consider this a hearing aid and therefore it is not covered. The process for upgrades is the same for new (and upgraded) softband requests. If a patient is interested in wearing a Ponto on a softband, please refer them to our Insurance Services Department so we can begin the process.

What is the CPT code used for a Ponto on a softband?

Whether it is an initial softband request or an upgrade, the HCPCS remains the same: L8692.  This includes the sound processor and the softband.

Contact Oticon Medical’s Insurance Services Department for help

Although you might not know everything there is to know about insurance and benefits, we hope that by increasing your  knowledge and understanding, you feel more confident managing patients and their insurance benefits. If you have any specific questions about insurance benefits as they pertain to Oticon Medical’s Ponto family of devices, please contact our Insurance Services Department at (855) 400-9761 or mailto:insuranceservices@oticonmedical.com.

About the Authors

Brianna Rusay is the Oticon Medical Insurance Services manager. Brianna has a master’s degree in Health Services Administration and over 10 years of health insurance experience. Brianna has worked in both the health care provider setting and the insurance setting, with a primary focus on Durable Medical Equipment.

Dianna Tingle-Gould, AuD, CCC-A is the Clinical Specialist in the Southeast region for Oticon Medical. She has practiced in hospital and neurotology settings in Houston, Texas and Birmingham, Alabama. She completed her training at Auburn University in 2018.

Courtney Smith, M.A., CCC/A, is the Clinical Trainer for Oticon Medical. She in in her 19th year of practicing audiology. She has practiced in private practice and university hospital settings in Las Vegas, NV. She completed her training at the University of Iowa in 2003.

Raising Awareness of Hearing Loss

To highlight and help increase awareness of hearing loss, this blog is dedicated to the efforts that surround the national campaign for May as Better Hearing and Speech Month. Hearing loss is ranked as one of the most common chronic health conditions that U.S. adults experience, affecting an estimated 48 million people nationwide. New polling released by the American Speech-Language-Hearing Association (ASHA) reveals an overwhelming disconnect between the high value that Americans say they place on their hearing and their low willingness to be treated for any hearing loss. This has prompted a new public service announcement (PSA) campaign: Act Now on Hearing. This PSA will air nationwide for the next year educating Americans on the signs of hearing loss and guiding those affected to find care from a certified audiologist.

People with hearing loss often wait an average of seven years before seeking treatment. When left untreated, hearing loss has been linked to several other health problems, including social isolation and depression, cognitive decline, and increased stress levels. A 12-year study found that mild hearing loss doubled dementia risk, moderate loss tripled risk, and people with a severe hearing impairment were five times more likely to develop dementia (Lin, et al, 2011).

Additional statistics learned from a poll conducted by ASHA of nearly 2,500 adults ages 18 and older found:

  • 80% of Americans say maintaining their hearing heath is extremely important or very important to their quality of life.
  • Only 2 in 10 (20%) adults have had a hearing test in the past five years, compared with roughly 6 in 10 (61%) who have had their vision tested.
  • More than half (51%) of all adults reported having hearing problems, but only 11% of those respondents have sought treatment.
  • More than three-quarters (78%) of those with hearing problems have had these difficulties for one or more years—and over one-third (35%) have had trouble for five or more years.
  • A 42% plurality of Americans understand that mild hearing loss can impact a person’s life or daily functioning. Yet, more than half of those with untreated hearing problems (56%) say that they would be unlikely to treat it unless it was “severe.”

Click through for additional information on Attitudes and Actions Towards Hearing Health Survey Results findings from ASHA.

A global spotlight

The World Health Organization (WHO) released the first-ever World Report on Hearing projecting that by 2050, 2.5 billion people will be living with some degree of hearing loss. This translates into 1 in 4 people worldwide, at least 700 million of whom will require rehabilitation services.

Hearing loss can be addressed through effective and timely interventions. In children, almost 60% of hearing loss is due to causes that can be prevented through measures such as immunization, improved maternal and neonatal care, and screening for, and early management of, otitis media. In adults, legislation on noise control and safe listening, and surveillance of ototoxicity can help maintain hearing trajectories and reduce the potential for hearing loss.

Click through to learn more about the World Report on Hearing.

Take action now

It is important to act now for a variety reasons, but in particular the recent COVID-19 pandemic highlights the importance of hearing, which allows us to remain connected to others when social distancing and losing visual cues due to the use of masks.

As audiologists we have the platform to help increase awareness, motivate those struggling with hearing loss to take that initial step toward treatment, educate others on hearing technology and its benefits, and counsel each patient we treat on the importance of protecting our ears from loud noises.

How can you get involved?  Consider any of the following:

  • Volunteer to present to your local community on the effects of hearing loss.
  • Post the present statistics surrounding hearing loss and the benefits of hearing technology on your social media accounts.
  • Offer free hearing screenings at your facility.
  • Encourage your inner circle of friends and family to complete a basic hearing test.
  • Lead by example and treat your own ears with kindness by reducing exposure to loud noises.

If we each commit to doing one thing to help raise awareness together, we can make a difference!

 

References

Kochkin S & Rogin C.  Quantifying the Obvious: The Impact of Hearing Instruments on Quality of Life;  The Hearing Review, January 2000.
Lin FR, Metter EJ, O'Brien RJ, Resnick SM, Zonderman AB, Ferrucci L. Hearing loss and incident dementia. Archives of neurology. 2011; 68(2):214-20. NIHMSID: NIHMS336097 PubMed PMID: 21320988, PMCID: PMC3277836
American Speech Language Hearing Association (ASHA) 2021. Attitudes and Actions Towards Hearing Health. Survey Results; www.asha.org
 World Health Organization (2021): Report on Hearing; www.who.int

About the Author:

Carissa Moeggenberg is an audiologist who has worked in the hearing healthcare field for the past 29 years. She is presently the Training Manager for Oticon Medical.

Female audiologist

Reducing the Clinic’s Burden: Online Patient Resources from Oticon Medical

The demand to provide hearing healthcare services remotely has reached new levels this past year due to the COVID-19 pandemic. Remote hearing healthcare is not new—it has been discussed in audiology research circles for more than 20 years, been piloted and launched by Government Services and used by clinicians serving remote geographic locations.

TeleHealth, as defined by the World Health Organization, is “the use of electronic means to deliver information, resources and services related to health”. TeleHealth covers many domains, including electronic health records, mobile health, and health analytics. TeleHealth (also called eHealth) has the potential to provide more services to a wider population in a personalized manner. Prior to 2020, it was primarily intended to supplement in-person appointments, but has taken on a new meaning due to the recent pandemic and need for social distancing.

Reducing the burden on clinics by providing support for patient-related services and offering remote assistance to patients is a priority for us at Oticon Medical, which is why we have either created or further expanded several online support services for our hearing healthcare professionals over the last year. We detail a short summary of these services in this first blog of the New Year.

The Ponto Care™ App was expanded specifically to address the need for social distancing. It now provides your patients with an Aftercare section allowing them to access relevant information about everyday life with the Ponto, including user guides, instructional videos and a diary. More importantly, the Aftercare section allows recipients to monitor their implant site to ensure proper care is taken should an issue with the healing process occur. The app provides recipients with the ability to photograph their implant site documenting any changes that may occur over time. These photos can be shared or discussed with their healthcare provider should an issue occur during their recovery process, thus empowering patients for simple, easy device care.

Replacement Processor Support is an essential service for you and your patients. Should your patient need a replacement sound processor, we will extract their current program from their non-functioning processor, load the program(s) onto their new sound processor and ship directly to the patient. This removes you from the process so that you can focus your time on clinically billable services.

Oticon Medical Online Support Pages

Patients often have many questions regarding the insurance reimbursement process during their journey to getting a Ponto System or when upgrading their current sound processor. In order to reduce the amount of time you spend counseling on topics related to insurance reimbursement we have expanded our online services to provide additional support for your patients. Our Insurance Support Team has posted online information that includes the list of in-network insurance providers, frequently asked questions, intake forms and direct contact information on how to reach a member of our team.

Additional online programs to assist your patients can be found on our website under Support.  This section of our website offers instructional product videos, online warranty registration and product use guides.

Ongoing guidance and support from other recipients who have been on the BAHS journey to better hearing play a key role in assisting patients who are new to this technology. We encourage you to direct your patients to our Oticon Medical Friends program

for a deeper connection that only another bone anchored recipient can impart, thus easing the amount of time you spend on counseling.

Finally, to provide a place for you to build your expertise about Oticon Medical’s products, we have partnered with Audiology Online to extend opportunities for you to attend live webinars or watch recorded webinars from the comfort of your home or office. These sessions are typically 60 minutes in length and offer continuing education credits. Topics include clinical evidence, product updates, product fittings and advanced clinical management of bone anchored recipients.

We Value Your Feedback

We are committed to continually evaluating the services we provide and developing innovative remote care solutions that present value to those customers who fit and receive our products. Should you have suggestions or ideas on how we can improve our remote service programs please let us know!

We wish you all the best for 2021! Your dedication and skill make a difference every day to those affected by hearing loss.