Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street Boston, MA 02111 www.mass.gov/dma

MASSHEALTH
TRANSMITTAL LETTER SHC-13
November 2003
TO:       Speech and Hearing Centers Participating in MassHealth
FROM:       Beth Waldman, Acting Commissioner
RE:       Speech and Hearing Center Manual (Changes to Service Codes and Service Descriptions)
This letter transmits revisions to the service codes and descriptions in the Speech and Hearing Center Manual. These revisions are effective for dates of service on or after December 1, 2003.
The Centers for Medicare and Medicaid Services (CMS) has revised the Healthcare Common Procedure Coding System (HCPCS). New national service codes have been added, and MassHealth local codes have been removed from the Speech and Hearing Center Manual. Please note that you must use a modifier with some codes to accurately reflect the service provided. The attached Subchapter 6 contains codes with modifiers, where applicable.
Billing Guidelines
In addition to the revised Subchapter 6, you will find a table that crosswalks the obsolete MassHealth local service codes to the new national service codes and modifiers. The crosswalk provides descriptions of both the old and new service codes and also provides the new standard service codes and their modifiers that must be used to bill MassHealth for speech and hearing center services provided on or after December 1, 2003.
The billable unit of service for a new standard code may differ from that of the obsolete local code. Some services must now be billed per hour, and others per 15 minutes. The attached Subchapter 6 describes each unit equivalent and the maximum billable units for each new service code.
Modifiers
Please refer to the attached Subchapter 6 and crosswalk table for instructions on when and how to use modifiers. Failure to use the appropriate modifier as required for a given service will result in a denied claim. The attached crosswalk explains which modifiers must be used with each service code, and describes the function of the modifier.

MassHealth
Transmittal Letter SHC-13 November 2003 Page 2
Infant Testing
Effective for dates of service beginning December 1, 2003, the MassHealth local code for infant testing (X9662) will be replaced by Current Procedural Terminology (CPT) codes 92585, 92586, 92587, and 92588. Providers must bill the applicable CPT code(s) for the individual tests that are performed.
Prior Authorization
Please refer to Subchapter 6 of the Speech and Hearing Center Manual to determine which codes require prior authorization from the Division. All requests for prior authorization submitted on or after December 1, 2003, must be submitted using the new standard service codes and modifiers, if applicable, as described in Subchapter 6. The Division will not accept prior-authorization requests submitted for dates of service on or after December 1, 2003, using obsolete local service codes.
Fee Schedule for New Service Codes
If you wish to obtain a fee schedule with the new service codes, you may purchase Division of Health Care Finance and Policy (DHCFP) regulations from either the Massachusetts State Bookstore or from DHCFP (see addresses and phone numbers below). You must contact them first for the price of the publication. You may also obtain the regulations from the DHCFP Web site at www.mass.gov/dhcfp. The regulation title is 114.3 CMR 39.00: Rehabilitation Clinic Services, Audiological Services, Restorative Services.
Massachusetts State Bookstore	Division of Health Care
State House, Room 116	Finance and Policy
Boston, MA 02133	Two Boylston Street
Telephone: 617-727-2834	Boston, MA 02116
www.mass.gov/sec/spr	Telephone: 617-988-3100
www.mass.gov/dhcfp
Questions
If you have any questions about this information please contact MassHealth Provider Services at 617-628-4141 or 1-800-325-5231.
NEW MATERIAL
(The pages listed here contain new or revised language.)
Speech and Hearing Center Manual
Pages vi, 6-1 and 6-2
OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)
Speech and Hearing Center Manual
Page vi, 6-1 and 6-2 — transmitted by Transmittal Letter SHC-12

MassHealth
Transmittal Letter SHC-13
October 2003
Attachment
Speech and Hearing Provider Service Crosswalk
Effective December 1, 2003

Obsolete Code	Obsolete Code Description	New
Service
Code	Modifier	New Code Description	Guideline	
92599	Unlisted otorhinolaryngological services or procedure (I.C.)	92700		Unlisted otorhinolaryngological service or procedure	Replace code per 2003 CPT manual (IC).	
X9641	Treatment of speech language, voice, communication, and/or auditory processing disorder (includes aural rehabilitation) (includes treatment for dysphasia); individual, each additional 15 minutes	92507		Treatment of speech, language, voice, communication, and/or auditory processing disorder (includes aural rehabilitation); individual	Bill in 15-minute increments, up to one hour.	
X9642	Treatment of speech, language, voice, communication, and/or auditory processing disorder (includes treatment for dysphasia); group, each additional 15 minutes	92508		Treatment of speech, language, voice, communication, and/or auditory processing disorder (includes aural rehabilitation); group, two or more individuals	Bill in 15-minute increments, up to one hour.	
X9653	Comprehensive pediatric speech and language evaluation (age 12 and younger)	92506	HA	Evaluation of speech, language, voice, communication, auditory processing, and/or aural rehabilitation status, child/adolescent program		
X9662	Infant testing	92585		Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive	Bill individual tests that were performed.	

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

	
	92587		Evoked otoacoustic emissions; limited (single stimulus level, either transient or distortion products)	

	
	92588		Evoked otoacoustic emissions; comprehensive or diagnostic evaluation (comparison of transient and/or distortion product otoacoustic emissions at multiple levels and frequencies)	
	
X9666	Aural rehabilitation therapy; individual (up to 30 minutes)	92507		Treatment of speech, language, voice, communication, and/or auditory processing disorder (includes aural rehabilitation); individual	Bill in 15-minute increments, up to the maximum of one hour.	
X9667	Aural rehabilitation therapy; group (up to 60 minutes) (each recipient)	92508		Treatment of speech, language, voice, communication, and/or auditory processing disorder (includes aural rehabilitation); group, two or more individuals	Bill in 15-minute increments, up to the maximum of one hour.	

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
SPEECH AND HEARING CENTER MANUAL	SUBCHAPTER NUMBER AND TITLE
TABLE OF CONTENTS	PAGE
vi	

	TRANSMITTAL LETTER
SHC-13	DATE
12/01/03	
6. SERVICE CODES AND DESCRIPTIONS
Audiological Services 		6-1
Other Procedures 		6-2
Speech and Language Services 		6-2
Appendix A. DIRECTORY 		A-1
Appendix B. ENROLLMENT CENTERS 		B-1
Appendix C. THIRD-PARTY LIABILITY CODES 		C-1
Appendix W EPSDT SERVICES: MEDICAL PROTOCOL AND
PERIOICITY SCHEDULE 		W-1
Appendix X FAMILY ASSISTANCE COPAYMENTS AND
DEDUCTIBLES 		X-1
Appendix Y. REVS CODES/MESSAGES 		Y-1
Appendix Z. EPSDT SERVICES LABORATORY CODES 		Z-1

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
SPEECH AND HEARING CENTER MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-1	

	TRANSMITTAL LETTER
SHC-13	DATE
12/01/03	
601   Service Codes and Descriptions
Note:
 (A)	I.C. indicates that the claim will receive individual consideration to determine payment. See 130 CMR 413.407 for I.C. requirements.
 (B)	Some service codes require prior authorization (P.A.). See 130 CMR 413.408 for prior authorization requirements.

Service Code

Modifier     Service Description

Audiological Services

92552 92553 92555 92556 92557
92562 92563 92564 92565 92567 92568 92569 92572 92576 92577 92582 92583 92584 92585
92586 92587
92588
92589 92590 92591 92592

Pure tone audiometry (threshold); air only
air and bone (S.P. to 92552) Speech audiometry threshold
with speech recognition Comprehensive audiometry threshold evaluation and speech recognition (92553 and
92556 combined) Loudness balance test, alternate binaural or monaural (S.P. to 92563 through 92565) Tone decay test (S.P. to 92562, 92564, and 92565) Short increment sensitivity index (SISI) (S.P. to 92562, 92563, and 92565) Stenger test, pure tone (S.P. to 92562 through 92564) Tympanometry (impedance testing) Acoustic reflex testing (S.P. to 92569) Acoustic reflex decay test (S.P. to 92568) Staggered spondaic word test (S.P. to 92576 and 92577) Synthetic sentence identification test (S.P. to 92571 and 92577) Stenger test, speech (S.P. to 92571 and 92576) Conditioning play audiometry Select picture audiometry (I.C.) Electrocochleography (I.C.)
Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive
limited Evoked otoacoustic emissions; limited (single stimulus level, either transient or
distortion products)
comprehensive or diagnostic evaluation (comparison of transient and/or
distortion product otoacoustic emissions at multiple levels and frequencies) Central auditory function test(s) (specify) Hearing aid examination and selection; monaural
binaural Hearing aid check, monaural (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.)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
SPEECH AND HEARING CENTER MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-2	

	TRANSMITTAL LETTER
SHC-13	DATE
12/01/03	
601   Service Codes and Descriptions (cont.)
Service
Code        Modifier     Service Description
92593	binaural
92594	Electroacoustical evaluation for hearing aid; monaural (real ear measurement (REM)
objective test of hearing instrument performance in the patient’s ear as compared to a target response and electroacoustical assessment of the performance evaluation of the hearing instrument as compared to its original factory specifications)
92595	binaural
92596	Ear protector attenuation measurements
Other Procedures
92700	Unlisted otorhinolaryngological service or procedure (I.C.)
Speech and Language Services
92506	Evaluation of speech, language, voice, communication, auditory processing, and/or
aural rehabilitation status  (per hour, maximum of three hours)
92506	HA	Evaluation of speech, language, voice, communication, auditory processing, and/or
aural rehabilitation status, child/adolescent program (for children (age of 12 and younger); per hour, maximum of four hours)
92507	Treatment of speech, language, voice, communication, and/or auditory processing
disorder (includes aural rehabilitation); individual (15 minutes, maximum four units per visit)
92508	group, two or more individuals (but less than seven individuals) (each member)
(15 minutes per unit, maximum four units per visit)
This publication contains codes that are copyrighted by the American Medical Association.