CPT guidance instructs that E/M (CPT Codes 99091, 99202-99499) should only be reported by physicians or other qualified health care professionals. In accordance with CMS guidelines, the only qualified health care professionals that may report E/M services are nurse practitioners (NP), clinical nurse specialists (CNS), certified nurse midwives (CNM), and physician assistants (PA).
Per the TMHP Vision and Hearing Services Handbook Section 2.2.3.3, the following procedure codes may be reimbursed for evaluative therapeutic services:
- 92620
- 92621
- 92625
Audiology providers may be reimbursed for services rendered in the office setting for procedure code 92621.
The above services are payable to audiologists in addition to the services listed under sections 2.2.3, 2.2.3.1, 2.2.3.2, and 2.2.3.4.
Next steps for Providers:
Providers should share this communication with their staff.
Resources:
For more information, please consult the following references:
- 2.2.3 Audiology and Audiometry Evaluation and Diagnostic Services – Section 2.2.3.3 Evaluative and Therapeutic Services 2_20_Vision_and_Hearing_Srvs.fm (tmhp.com)
- American Medical Association, Current Procedural Terminology (CPT®) Professional Edition and associated publications and services.
- Centers for Medicare and Medicaid Services, CMS Manual System, and other CMS publications and services
- Centers for Medicare and Medicaid Services, Healthcare Common Procedure Coding System, HCPCS Release and Code Sets
Community First Resources:
https://communityfirsthealthplans.com/provider-newsletter
https://communityfirsthealthplans.com/providers/
Contact:
Email ProviderRelations@cfhp.com or call 210-358-6294.