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 SHC-15 
April 2005

	TO:	Speech and Hearing Centers Participating in MassHealth

	FROM:	Beth Waldman, Medicaid Director  

	RE:	Speech and Hearing Center Manual (Changes to Service Codes and Descriptions)

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

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 speech and hearing center services is 114.3 CMR 39.00:  Rehabilitation Clinics, Audiological and Restorative Services.

	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 code book.  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

MASSHEALTH
TRANSMITTAL LETTER SHC-15 
April 2005
	Page 2

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

	Speech and Hearing Center Manual

	Pages 6-1 and 6-2

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(The pages listed here are no longer in effect.)

	Speech and Hearing Center Manual

	Pages 6-1 and 6-2 – transmitted by Transmittal Letter SHC-13

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	Pure tone audiometry (threshold); air only
92553		air and bone (S.P. to 92552)
92555	Speech audiometry threshold
92556	with speech recognition
92557	Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined)
92562	Loudness balance test, alternate binaural or monaural (S.P. to 92563 through 92565)
92563	Tone decay test (S.P. to 92562, 92564, and 92565)
92564	Short increment sensitivity index (SISI) (S.P. to 92562, 92563, and 92565)
92565	Stenger test, pure tone (S.P. to 92562 through 92564)
92567	Tympanometry (impedance testing)
92568	Acoustic reflex testing (S.P. to 92569)
92569	Acoustic reflex decay test (S.P. to 92568)
92572	Staggered spondaic word test (S.P. to 92576 and 92577)
92576	Synthetic sentence identification test (S.P. to 92571 and 92577)
92577	Stenger test, speech (S.P. to 92571 and 92576)
92582	Conditioning play audiometry 
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)
92590	Hearing aid examination and selection; monaural
92591	binaural
92592	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.)
92593	binaural

Service
Code   	Modifier	Service Description

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 
92620	Evaluation of central auditory function, with report; initial 60 minutes
92621	Evaluation of central auditory function, with report, each additional 15 minutes (up to the maximum of eight units billed)

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.