CODING AND REIMBURSEMENT | CPT Coding Changes for 2021: Auditory Evoked Potentials and Vestibular Evoked Myogenic Potentials

By Anna Marie Jilla and Annette A. Burton

This article is a part of the January/February 2021, Volume 33, Number 1, Audiology Today issue.

Introduction

The American Academy of Audiology (the Academy), together with the American Speech-Language-Hearing Association (ASHA), continuously reviews the CPT code set applicable to audiologists. The goal is to ensure that audiologists have appropriate codes to report that accurately describe and reflect the services they perform for patients.

Our organizations, with support from the American Academy of Neurology and the American Academy of Otolaryngology-Head and Neck Surgery, led an effort to obtain new codes for the reporting of auditory evoked potentials (AEPs) and vestibular evoked myogenic potentials (VEMPs).

In 2017, CPT code 92585 – Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive was identified by the American Medical Association (AMA)/Specialty Society Relative Value Scale Update Committee’s Relativity Assessment Workgroup in a screening that identifies procedures billed to Medicare with use counts of more than 30,000. Because code 92585 had not been reviewed since 1996, an action plan was created to refer 92585 to the AMA CPT Editorial Panel.

Since the initial development of CPT 92585 and 92586, there have been significant changes in practice patterns and procedures for evaluating the AEP response. With only two codes (92585 and 92586) to encompass the wide variety of AEP procedures, the creation of more specific codes and descriptors seemed to be a logical next step for the AEP code family.

VEMP testing originally did not have a separate and distinct CPT code. Prior to the creation of new codes in this area, VEMP testing was reported using 92700–Unlisted otorhinolaryngological procedure (CPT Assistant, 2011).

Discussion among CPT representatives from the Academy, the American Speech-Language-Hearing Association (ASHA), the American Academy of Neurology (AAN), and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) resulted in a plan to:

• Eliminate two of the existing codes in the AEP family:

92585 (Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive)

92586 (Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; limited)

• Propose four new codes for AEP testing:

Three new codes related to the assessment of hearing function.

One new code related to the diagnostic assessment of auditory nervous system integrity.

• Create code(s) for VEMP testing.

DELETED CODES	DESCRIPTION
92585	Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive
92586	Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; limited
NEW AEP CODES	DESCRIPTION
92650	Auditory evoked potentials; screening of auditory potential with broadband stimuli, automated analysis
92651	Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report
92652	Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report (Do not report 92652 in conjunction with 92651.)
92653	Auditory evoked potentials; neurodiagnostic, with interpretation and report
NEW VEMP CODES	DESCRIPTION
92517	Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP) (Do not report 92517 in conjunction with 92270,* 92518, 92519.)
92518	Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; ocular (oVEMP) (Do not report 92518 in conjunction with 92270,* 92517, 92519.)
92519	Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP) and ocular (oVEMP) (Do not report 92519 in conjunction with 92270,* 92517, 92518.)

New AEP Codes

As indicated above, the first three of the new AEP codes relate to the assessment of hearing function and the fourth code is specifically designed to report activities related to neurodiagnostic, site of lesion testing (CPT Assistant, 2020). It should be noted that these codes do not reflect new AEP procedures, but more clearly define the work that is involved for each code.

92650—Auditory evoked potentials; screening of auditory potential with broadband stimuli, automated analysis

This code would be reported when using automated testing procedures to determine whether AEP responses are present or absent (pass/refer response). This procedure would be most commonly used in universal newborn hearing screening programs, but may be used under certain circumstances in other places of service for patients who are not newborns.

92651—Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report

This code would be reported when using non-automated testing procedures for hearing-status determination. Typically, AEP responses to broadband stimuli are obtained at moderate to high levels and at a lower intensity level. The higher levels are used to evaluate the neural integrity of the AEP response (e.g., to rule out auditory neuropathy, sensory or permanent conductive hearing loss). At higher levels, wave-form identification, integrity, absolute and inter-wave latencies are analyzed. The lower stimulus levels are used to identify normal AEP function or to confirm hearing impairment and the need for additional frequency-specific threshold testing (see 92652).

92652—Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report (Do not report 92652 in conjunction with 92651.)

This code would be reported for activities related to the determination of type, severity, and configuration of hearing loss by measuring the auditory brainstem response (ABR) or auditory steady-state response (ASSR) threshold response at multiple frequencies. Since the higher intensity level waveform analysis described in 92561 is typically performed in conjunction with threshold identification, 92561 should not be reported in conjunction with 92652, as the work of 92561 is accounted for in the valuation of 92652.

92653—Auditory evoked potentials; neurodiagnostic, with interpretation and report

This code would be reported for activities related to neurodiagnostic evaluation of the VIII cranial nerve and/or auditory brainstem. Differentiating characteristics of 92653 and 92651 pertain to the motivations and impetus for testing. For example, if the primary concern is neurologic in nature (e.g., a space-occupying lesion or the integrity of the VIII cranial nerve and/or the auditory brainstem), 92653 would be reported.

The 92653 procedure serves to identify a primary neurologic concern, of which hearing loss may or may not be a secondary concern. It is not appropriate to report 92653 in conjunction with other AEP codes (92651 and 92652), as these procedures are distinct and separate in their descriptions and professional work.

New VEMP Codes

92517—Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP) (Do not report 92517 in conjunction with 92270, 92518, 92519.)

This code would be reported for evaluation of function of the saccule and inferior vestibular nerve (cVEMP response). Report when only a cVEMP evaluation is performed.

92518—Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; ocular (oVEMP) (Do not report 92518 in conjunction with 92270, 92517, 92519.)

This code would be reported for evaluation of function of the utricle and superior vestibular nerve. (oVEMP response).  Report when only an oVEMP evaluation is performed.

92519—Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP) and ocular (oVEMP) (Do not report 92519 in conjunction with 92270, 92517, 92518.)

This code would be reported for evaluation of both saccular and utricular function, as well as the superior and inferior portions of the vestibular nerve (cVEMP and oVEMP responses). Report when both cVEMP and oVEMP evaluations are performed.

Conclusion

As clinicians begin reporting these new CPT codes on January 1, 2021, it is expected that case-specific questions may arise. Members are encouraged to contact the Academy’s Coding and Reimbursement Committee at reimbursement@audiology.org for more information. Additional educational resources from the Academy to support continued learning will be forthcoming.

CPT codes, descriptions, and other data are copyright 1966, 1970, 1973, 1977, 1981, 1983–2021 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

DISCLAIMER

The purpose of the information provided above by the American Academy of Audiology Coding and Reimbursement Committee is strictly for educational guidance to audiologists. Action taken with respect to the information provided is an individual choice. The American Academy of Audiology hereby disclaims any responsibility for the consequences of any action(s) taken by any individual(s) as a result of using the information provided, and reader agrees not to take action against, or seek to hold, or hold liable, the American Academy of Audiology for the reader’s use of the information provided. As used herein, the “American Academy of Audiology” shall be defined to include its directors, officers, employees, volunteers, members, and agents.