By Andrea Gohmert, Shawna Jackson, and Anna Marie Jilla
This article is a part of the November/December 2021, Volume 33, Number 6, Audiology Today issue.
Every health-care profession deals with changes and challenges, especially in reimbursement. Stories of increased competition and decreased compensation are ever present in today’s environment across many health professions. Diligent monitoring of changes related to coding and reimbursement is key to ensuring access to services for the public, as well as payment for services rendered by providers.
In January 2021, for the first time since 1996, a change was made in the Current Procedural Terminology (CPT) codes assigned to auditory evoked potentials (AEP). As a result of efforts from multiple national organizations, two generic codes became four more specific codes designed to better reflect current practices and better describe AEP-related procedural work performed by audiologists.
Changes to procedure codes can initially result in reimbursement delays for providers while payers update their fee schedules. With national changes to procedure codes, payer policies for contracted government providers and commercial insurance companies must also be updated. In the state of Texas, the new code changes resulted in the Texas Medicaid and Healthcare Partnership initially limiting reimbursement for CPT codes 92652 (Auditory Evoked Potential—threshold estimation) and 92653 (Auditory Evoked Potential—neurodiagnostic) to physician taxonomies and would not reimburse audiologists, the primary providers of these services.
In a state where nearly 50 percent of infants are covered under state Medicaid health-care insurance programs, payer policy omitting audiologists as providers of AEP services constituted a significant barrier to access for families and was problematic for facilities that must meet federal requirements related to early-hearing-loss detection and intervention. The following timeline provides an account of the actions taken to resolve payer policy issues related to the new AEP codes.
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