Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth	

MASSHEALTH
TRANSMITTAL LETTER AUD-12 
January 2005

	TO:	Audiologists Participating in MassHealth

	FROM:	Beth Waldman, Medicaid Director 

	RE:	Audiologist Manual (Changes to Service Codes and Descriptions; Clarification of Certain Billing Procedures)

This letter transmits revisions to the service codes and descriptions listed in Subchapter 6 of the Audiologist Manual.  These revisions are effective for dates of service on or after February 1, 2005.

This letter also clarifies certain billing procedures for hearing aid options/accessories and earmolds.

If you want to obtain a fee schedule, you may purchase Division of Health Care Finance and Policy regulations from either the Massachusetts State Bookstore or directly from the Division of Health Care Finance and Policy (see addresses and telephone numbers below).  You must contact them first to find out the price of the regulation.  The Division of Health Care Finance and Policy also has the regulations available on disk and on their Web site.  The regulation title for audiologist services is 114.3 CMR 39.00:  Rehabilitation Clinics, Audiological and Restorative Services.  The regulation title for hearing aid services is 114.3 CMR 23.00:  Hearing Aid Dispensers.

	Massachusetts State Bookstore		Division of Health Care Finance and Policy
	State House, Room 116		Two Boylston Street
	Boston, MA  02133		Boston, MA  02116
	Telephone:  617-727-2834		Telephone:  617-988-3100
	www.mass.gov/sec/spr		www.mass.gov/dhcfp

Changes to Service Codes and Descriptions

Central Auditory Function Test(s)

Service Code 92589 has been deleted from the CPT 2005.  Effective for dates of service on or after February 1, 2005, providers must bill using the following replacement service codes.  Please note the different billing units for these service codes.

92620	Evaluation of central auditory function, with report; initial 60 minutes
92621	Evaluation of central auditory function, with report; each additional 15 minutes

Cochlear Implant Batteries

Effective for dates of service on or after February 1, 2005, providers must bill for cochlear implant batteries using the following new specific HCPCS codes.  If none of these codes is appropriate, the hearing aid supplies/accessories code V5267 may still be used. These services will be paid in accordance with 114.3 CMR 23.00.

L8620	Lithium ion battery for use with cochlear implant device, replacement, each
L8621	Zinc air battery for use with cochlear implant device, replacement, each
L8622	Alkaline battery for use with cochlear implant device, any size, replacement, each

Billing Procedures for Earmolds and Hearing Aid Options/Accessories

Manufacturer’s Invoice Required for Payment

In September 2003, MassHealth issued Transmittal Letter AUD-10, which transmitted revisions to and provided a crosswalk of old-to-new service codes.  A portion of that crosswalk is reprinted below.

Obsolete Code – Description	New Code	New Code Description	Guideline	
X5294 - Accessories; costing $35.00 or less	V5267	Hearing aid supplies/accessories	Use appropriate HCPCS code, regardless of unit cost.	
X5298 - Earmold; costing $35.00 or less per unit	V5264	Ear mold/insert, not disposable, any type	Use appropriate HCPCS code, regardless of unit cost.	
	V5265	Ear mold/insert, disposable, any type		
X5299 - Earmold; costing more than $35.00 per unit	V5264	Ear mold/insert, not disposable, any type	Use appropriate HCPCS code, regardless of unit cost.	
	V5265	Ear mold/insert, disposable, any type		
X5300 - Accessories; costing more than $35.00	V5267	Hearing aid supplies/accessories	Use appropriate HCPCS code, regardless of unit cost.	

Each of the three new service codes in the above table represents a merging of two now obsolete service codes, which were formerly billed according to the cost of the earmold or accessory.  The new service codes must now be billed regardless of cost.  

MassHealth pays for these services in accordance with 114.3 CMR 23.00.  Effective for all claims submitted on or after February 1, 2005, providers must submit a manufacturer’s invoice with MassHealth claims for ALL earmolds and options/accessories billed under Service Codes V5264, V5265, and V5267, regardless of the cost of the earmolds or options/accessories.  Claims that do not include a complete, unaltered manufacturer’s invoice will be denied.  Invoices that have been obscured or otherwise altered, catalogue price lists, and monthly manufacturer’s statements are not acceptable.

Units of Service for Hearing Aid Options/Accessories

Effective for all claims submitted on or after February 1, 2005, options/accessories should no longer be combined into one unit of service as explained in Transmittal Letter AUD-7 (August 1998).  All options/accessories billed under service code V5267 must still be combined on one line of the Claim Form no. 9, or its electronic equivalent, and billed separately from the hearing aid, but should be entered as the actual number of units provided.  For example, one battery door and two replacement cords should be entered on a single claim line as three units of service.  The total charge should represent all three components.

NEW MATERIAL
(The pages listed here contain new or revised language.)

Pages 6-1 through 6-4

OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)

Pages 6-1 and 6-2 – transmitted by AUD-10

Pages 6-3 and 6-4 – transmitted by AUD-11

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series	
SUBCHAPTER NUMBER AND TITLE

6  SERVICE CODES AND DESCRIPTIONS	
PAGE

6-1	

AUDIOLOGIST MANUAL
	
TRANSMITTAL LETTER

AUD-12 	
DATE

02/01/05	

601	Service Codes and Descriptions

Service
Code-Modifier			Service Description

AUDIOLOGICAL SERVICES

Vestibular Function Tests, with Recording and Medical Diagnostic Evaluation

92541		Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording
92542		Positional nystagmus test, minimum of 4 positions, with recording
92543	Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests), with recording
92544	Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording
92545	Oscillating tracking test, with recording
92546	Sinusoidal vertical axis rotational testing
92547	Use of vertical electrodes (List separately in addition to code for primary procedure.)

Audiologic Function Tests with Medical Diagnostic Evaluation

92552	Pure tone audiometry (threshold); air only (S.P. 92553)
92553		air and bone 
92555	Speech audiometry threshold (S.P. 92556)
92556		with speech recognition
92557	Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined)
92563	Tone decay test
92565	Stenger test, pure tone 
92567			Tympanometry (impedance testing)
92568			Acoustic reflex testing 
92569			Acoustic reflex decay test
92572			Staggered spondaic word test (S.P. 92589)
92576			Synthetic sentence identification test (S.P. 92589)
92577			Stenger test, speech
92579			Visual reinforcement audiometry (VRA)
92582			Conditioning play audiometry (I.C.)
92583			Select picture audiometry (I.C.)
92584			Electrocochleography (I.C.)
92585		Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive
92586				limited
92587			Evoked otoacoustic emissions; limited (single stimulus level, either transient or distortion products)
92588				comprehensive or diagnostic evaluation (comparison of transient and/or distortion product otoacoustic emissions at multiple levels and frequencies)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series	
SUBCHAPTER NUMBER AND TITLE

6  SERVICE CODES AND DESCRIPTIONS	
PAGE

6-2	

AUDIOLOGIST MANUAL
	
TRANSMITTAL LETTER

AUD-12 	
DATE

02/01/05	

601	Service Codes and Descriptions (cont.)

Service
Code-Modifier			Service Description

92590			Hearing aid examination and selection; monaural
92591				binaural
92592			Hearing aid check; monaural (provider was not the original dispenser and the instrument is
older than one year) (listening check of the instrument plus sound field testing of the instrument on the patient; may or may not be performed together with a diagnostic evaluation)
92593				binaural
92594		Electroacoustic evaluation for hearing aid; monaural
92595				binaural
92596		Ear protector attenuation measurements (I.C.)
92620	Evaluation of central auditory function, with report; initial 60 minutes
92621		each additional 15 minutes (maximum of three hours total, including the initial 60 minutes billed under 92620)

	Other Audiological Procedures

92700			Unlisted otorhinolaryngological service or procedure (I.C.)

		Aural Rehabilitation:  Lip Reading or Auditory Training

92507			Treatment of speech, language, voice, communication, and/or auditory processing disorder (includes aural rehabilitation); individual (bill in 15-minute units, up to a maximum of one hour)
92508				group, two or more individuals (per member, up to 60 minutes) (bill in 15-minute units, up to a maximum of one hour)

				Cochlear Implant Service Contract

V5014-MS		Repair/modification of a hearing aid — six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty (I.C.)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series	
SUBCHAPTER NUMBER AND TITLE

6  SERVICE CODES AND DESCRIPTIONS	
PAGE

6-3	

AUDIOLOGIST MANUAL
	
TRANSMITTAL LETTER

AUD-12	
DATE

02/01/05	

601	Service Codes and Descriptions (cont.)

Service
Code-Modifier			Service Description

HEARING AID SERVICES

		Office Visits for Evaluation and Management Services

99499	Unlisted evaluation and management service (up to a maximum of six services per member per date of service). (Providers may submit a prior-authorization request pursuant to 130 CMR 450.144(A) for members under 21 for units in excess of six per member per date of service.)

	Refitting Services/Other Professional Services

V5011	Fitting/orientation/checking of hearing aid

Hearing Aid Purchases-Monaural

V5030	Hearing aid, monaural, body worn, air conduction (P.A. if cost exceeds $500) (I.C.)
V5040	Hearing aid, monaural, body worn, bone conduction (P.A. if cost exceeds $500) (I.C.)
V5050	Hearing aid, monaural, in the ear (P.A. if cost exceeds $500) (I.C.)
V5060	Hearing aid, monaural, behind the ear (P.A. if cost exceeds $500) (I.C.)
V5246	Hearing aid, digitally programmable analog, monaural, ITE (in the ear) (P.A. if cost exceeds $500) (I.C.)
V5247	Hearing aid, digitally programmable analog, monaural, BTE (behind the ear) (P.A. if cost exceeds $500) (I.C.)
V5256	Hearing aid, digital, monaural, ITE (P.A. if cost exceeds $500) (I.C.)
V5257	Hearing aid, digital, monaural, BTE (P.A. if cost exceeds $500) (I.C.)

Hearing Aid Purchases-Binaural

V5130	Binaural, in the ear (P.A. if cost exceeds $1,000) (I.C.)
V5140	Binaural, behind the ear (P.A. if cost exceeds $1,000) (I.C.)
V5150	Binaural, glasses (P.A. if cost exceeds $1,000) (I.C.)
V5252	Hearing aid, digitally programmable, binaural, ITE (P.A. if cost exceeds $1,000) (I.C.)
V5253	Hearing aid, digitally programmable, binaural, BTE (P.A. if cost exceeds $1,000) (I.C.)
V5260	Hearing aid, digital, binaural, ITE (P.A. if cost exceeds $1,000) (I.C.)
V5261	Hearing aid, digital, binaural, BTE (P.A. if cost exceeds $1,000) (I.C.)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series	
SUBCHAPTER NUMBER AND TITLE

6  SERVICE CODES AND DESCRIPTIONS	
PAGE

6-4	

AUDIOLOGIST MANUAL
	
TRANSMITTAL LETTER

AUD-12	
DATE

02/01/05	

601	Service Codes and Descriptions (cont.)

Service
Code-Modifier			Service Description

Hearing Aid Purchases-CROS and BICROS

V5170	Hearing aid, CROS, in the ear (P.A. if cost exceeds $1,000) (I.C.)
V5180	Hearing aid, CROS, behind the ear (P.A. if cost exceeds $1,000) (I.C.)
V5190	Hearing aid, CROS, glasses (P.A. if cost exceeds $1,000) (I.C.)
V5210	Hearing aid, BICROS, in the ear (P.A. if cost exceeds $1,000) (I.C.)
V5220	Hearing aid, BICROS, behind the ear (P.A. if cost exceeds $1,000) (I.C.)
V5230	Hearing aid, BICROS, glasses (P.A. if cost exceeds $1,000) (I.C.)

Hearing Aid Purchases-Other

V5070	Glasses, air conduction (I.C.)
V5080	Glasses, bone conduction (I.C.)
V5100	Hearing aid, bilateral, body worn (I.C.)
V5274	Assistive listening device, not otherwise specified (P.A.) (I.C.) (Use this code only for pockettalkers.)
V5298	Hearing aid, not otherwise classified (P.A.) (I.C.)

	Hearing Aid Repairs, Accessories, and Related Services

V5014	Repair/modification of a hearing aid (I.C.)
V5264		Ear mold/insert, not disposable, any type (I.C.)
V5265	Ear mold/insert, disposable, any type (I.C.)
V5266	Battery for use in hearing device (per battery)
V5267	Hearing aid supplies/accessories (I.C.)
V5275	Ear impression, each
V5299		Hearing service, miscellaneous (P.A.) (I.C.)

Cochlear Implant Batteries

L8620	Lithium ion battery for use with cochlear implant device, replacement, each (I.C.)
L8621	Zinc air battery for use with cochlear implant device, replacement, each (I.C.)
L8622	Alkaline battery for use with cochlear implant device, any size, replacement, each (I.C.)

Hearing Aid Dispensing Fees

V5160	Dispensing fee, binaural
V5200	Dispensing fee, CROS
V5240	Dispensing fee, BICROS
V5241	Dispensing fee, monaural hearing aid, any type