Effective January 1, 2024, audiologists who program auditory osseointegrated implant (AOI) devices will have two newly established Current Procedural Terminology (CPT©, American Medical Association) codes to report their services.
CPT Codes 92622 and 92623 have established service descriptors and assigned Relative Value Units (RVUs), allowing professionals a predictable pathway for reimbursement of services rendered.
CPT 92622: Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; first 60 minutes
CPT 92623: Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; each additional 15 minutes
Five recommendations to prepare:
- Familiarize yourself with the new codes and descriptors so you know when and how to use them.
- Update the clinic’s superbill to include these new codes. If you are unfamiliar with superbills or would like to review templates, ASHA, AAA, and ADA offer resources and templates which you may find useful.
- Educate and coordinate with billing staff, billing software vendors, or Electronic Data Interchange (EDI) clearinghouse to ensure they are also aware of and ready for claims with the new service codes.
- Establish charges for the new codes and services which align with the clinic’s pricing protocol and policy and procedures.
- While healthcare professionals have discretion to charge appropriate amounts for their services, charges should remain consistent, regardless of type of payment or patient’s insurance status.
- Need more information on establishing fees? Read more about defining what are usual, customary, and reasonable fees, choosing pricing philosophies and working with private health plans, and calculating hourly rate thresholds.
- Review/Update your clinic’s billing procedures.
- Prior to the appointment:
- Confirm patient information, insurance information, and coverage details.
- Verify coverage of services by health plans and potential prior authorization requirements.
- Confirm/inform patients of any financial responsibility and consider collecting copayments at the appointment.
- After the appointment:
- Complete notes and documentation of services rendered to support medical necessity of care.
- Include a clear description reflecting the time associated with the services.
- Capture relevant information on superbill or in billing software to prepare claims for filing.
- Prior to the appointment:
- Complete a claims review to ensure payers process claims appropriately.
- Track the initial claims with these new CPT codes across insurance payers using the new AOI fitting codes.
- Compare allowed amounts for covered services to fee schedules/negotiated contracted rates.
- Review the remittance advice to understand any denial reasons, and file appeals when pathways are available.
- Follow up with any payers if new CPT codes have not been uploaded in their annual update.
- Share a written request for adoption of codes within the audiology code set. Provide a summary of the CPT code(s), descriptor(s), and service(s) included.
- Appeal any denials for non-covered services based on the CPT code reported.
For any questions or additional resources, please reach out to your Cochlear Market Access & Payer Strategy (MAPS) Manager. You can locate your regional manager’s contact information here: MAPS Manager Contact Information
All specific references to CPT codes and descriptions are ©2023 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CPT and CPT material are copyrights of American Medical Association (AMA): CPT Copyright 2020 American Medical Association, all rights reserved. CPT is a registered trademark of the American Medical Association.
The information provided in this document is provided as guidelines only to address the unique nature of implantable hearing solutions technology. This information does not constitute reimbursement or legal advice. Cochlear Americas makes no representation or warranty regarding this information or its completeness, accuracy, fitness for any purpose, timeliness, or that following these guidelines will result in any form of coverage or reimbursement from any insurance company or federal health care program payer. The information presented herein is subject to change at any time. This information cannot and does not contemplate all situations that a health care professional may encounter. To be sure that you have the most current and applicable information available for your unique circumstances, please consult your own experts and seek your own legal advice regarding your reimbursement and coding needs and the proper implementation of these guidelines. All products should be used according to their labelling. In all cases, services billed must be medically necessary, actually performed, and appropriately documented in the medical record.
