CODING AND REIMBURSEMENT | Specialty Series: Pediatric Assessment

By Mariah Cheyney and Jennifer Frank

This article is a part of the July/August 2020, Volume 32, Number 4, Audiology Today issue.

In January 2020, the American Academy of Audiology (the Academy) published its Clinical Guidance Document on the Assessment of Hearing in Infants and Young Children. The document covers four content areas: Pediatric Audiometry, Acoustic Immittance, Otoacoustic Emissions, and Electrophysiologic Audiometry. This article provides guidance on filing claims for pediatric audiometry and electrophysiologic audiometry.

Coverage policies for pediatric assessment will vary from payer to payer. Benefits provided through Medicaid or Children’s Health Insurance Program (CHIP) plans will vary from state to state. Clinicians are encouraged to contact insurers and reference coverage policies regarding payer-specific coding guidance. The purpose of this article is to discuss considerations when filing claims for pediatric assessment procedures.

Pediatric Audiometry

Behavioral Audiometry

Behavioral audiometric evaluation methods will vary given the patient age. Behavioral observation audiometry (BOA), visual reinforcement audiometry (VRA), and conditioned play audiometry (CPA) are standard clinical procedures used to assess hearing in infants, children, and difficult-to-test patients. 

BOA does not currently have a unique code for billing applications. This section will discuss considerations when billing for VRA and CPA procedures using the following current procedural terminology codes (CPT©, American Medical Association).

92579 Visual Reinforcement Audiometry is used to estimate hearing sensitivity by determining the type and severity of hearing loss using a reinforced response procedure. Code descriptions of 92579 reflect standard clinical assessment practices, necessitate the use of calibrated equipment, and include recording and interpretation of results (CPT Manual©, 2020). 92579 can be used when obtaining responses via soundfield speakers, headphones, insert earphones, or a bone oscillator. 

Currently, no specific guidance is provided on a minimum number of responses needed to bill this code. In cases of uncertainty, clinicians should consider congruence with standard clinical practices when reporting this code. 92579 does include assessment of speech threshold, a standard of clinical practice when conducting VRA, and is therefore not customarily billed in combination with Speech Threshold Audiometry (92555).