Cochlear Americas has a group of reimbursement experts, which make up the Otologic Management Services (OMS) team. OMS is a dedicated team of reimbursement specialists who are available, at no-cost, to help healthcare providers and candidates obtain the necessary insurance approval or to support appeals where coverage has been denied for Cochlear’s Nucleus® Cochlear Implants or Baha® Systems for medically qualified candidates. Access OMS’s support to help your patients obtain approval for coverage of their hearing implants from their health plan.
By Kalisha Barrett, Senior Manager Health Policy
On April 30, 2020, the Centers for Medicare & Medicaid Services (CMS) announced new rules to further expand telehealth for Medicare beneficiaries. CMS will temporarily reimburse audiologists and speech-language pathologists (SLPs) for providing telehealth services to Medicare Part B beneficiaries, in response to the COVID-19 pandemic. This expansion is retroactive to March 1, 2020 and will continue throughout the duration of the COVID-19 public health emergency (PHE).
What does this mean for enrolled Medicare providers?
- Providers may no longer enter into private payment arrangements with Medicare beneficiaries for any services that are included on Medicare’s approved telehealth services.
- If any covered telehealth services were provided to Medicare beneficiaries in a private pay arrangement since March 1, 2020, the providers should refund patients and instead submit a Medicare claim.
What does this mean for unenrolled Medicare providers?
- Providers may not enter into private pay arrangements with Medicare beneficiaries for covered telehealth services provided from March 1, 2020 and during the PHE.
- Providers should refund beneficiaries for funds collected that were associated with covered telehealth services for services provided since March 1, 2020.
- Unenrolled providers may not submit claims to Medicare for reimbursement for covered telehealth services during the PHE.
CMS added the following codes to allow audiologists to provide Medicare telehealth services to cochlear implant recipients:
|CPT Code||Code Description|
|92601||Diagnostic analysis of cochlear implant, patient younger than 7 years of age; with programming|
|92602||Diagnostic analysis of cochlear implant, patient younger than 7 years of age; with programming; subsequent programming|
|92603||Diagnostic analysis of cochlear implant, age 7 years or older; with programming|
|92604||Diagnostic analysis of cochlear implant, age 7 years or older; with programming; subsequent programming|
CMS added the following codes to allow SLPs to provide Medicare telehealth services:
|CPT Code||CPT Description|
|92507||Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual|
|92508||Treatment of speech, language, voice, communication, and/or auditory processing disorder; group|
|92521||Evaluation of speech fluency (eg, stuttering, cluttering)|
|92522||Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria);|
|92523||Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language)|
|92524||Behavioral and qualitative analysis of voice and resonance|
As a part of CMS expansion of services, speech-language pathology services can be provided via telephone-only when the patient does not have access to audiovisual equipment.
Both audiologists and SLPs should bill the same CPT codes they would for an in-person appointment, along with the place of service code that represents the in-person service. Providers will need to append the modifier -95 (synchronous telemedicine service) to each CPT code provided via telehealth. During the PHE, Medicare will reimburse these telehealth services at the same rate as in-person services paid under the Medicare Physician Fee schedule for Part B services.
The American Speech-Language-Hearing Association (ASHA) , the American Cochlear Implant Alliance (ACIA), and the American Academy of Audiology (AAA) have published additional guidance on Medicare telehealth services during the COVID-19 pandemic. It is important to note that the professional societies were instrumental in working with CMS to advocate for expanded Medicare telehealth service for audiologists and speech language pathologists. Providers are encouraged to support their professional societies as they continue to advocate for permanent expansion of telehealth services in the regulatory framework.
To learn more about providing telehealth services, check out these additional resources:
Covid 19 updates and resources available to providers, including template to request a Medicaid Waiver for providing speech language and audiology services via telehealth. https://www.acialliance.org/page/covid-19updates
Providing Teleheath Services Under Medicare During COVID-19 Pandemic:
Telehealth coverage tracking by state:
Telehealth coverage tracking by commercial insurance plan:
Telehealth coverage tracking of Medicaid by state:
COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers:
Covered telehealth services during COVID 19 PHE:
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All specific references to CPT codes and descriptions are ©2020 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 labeling. In all cases, services billed must be medically necessary, actually performed, and appropriately documented in the medical record.
By Nicole Craig, Senior Manager of Managed Care and Market Access, Cochlear Americas
At Cochlear, we are committed to ensuring patient access to implantable hearing solutions, extending from the earliest days of candidacy through a lifetime of service and support for our recipients.
Last month we posted information on best practices for obtaining commercial coverage for cochlear implant and bone anchored systems. This month we’d like to share a real-world success story that demonstrates how Cochlear’s Otologic Management Services (OMS) team works collaboratively with other stakeholders to ensure patient access to Hear now. And always
Patient story: Richard, age 35, Missouri
Becky Berkley, Sr. Reimbursement Specialist for OMS, recalls receiving an appeal request in October 2018 from the provider clinic of patient Richard. His unilateral Cochlear™ Nucleus® Profile Implant surgery was tentatively scheduled for December 12, 2018. His insurance carrier had denied his cochlear implant as a plan benefit exclusion, stating that his employer only covered cochlear implants for persons under age 27 – a criteria that Richard did not meet.
Richard remembers receiving the denial. “I received a letter in the mail that stated there was an error made and my surgery was denied. My heart broke. Receiving this implant was going to be a life changer for me and my family. At that moment I felt like that future had just been ripped away from me. But I was not going to let that denial letter stop me.”
Becky explained to Richard that the insurance plan elected by his employer was self-funded and suggested he reach out to his company’s Benefit Plan Administrator in the Human Resources department to inquire if they would be willing to review the procedure and pursue a benefit exception on his behalf.
“I was able to go to the headquarters to meet with the Director of Human Resources. After meeting with her and sharing my story, she said she would do whatever she could to help me. She suggested that I schedule an appeal hearing and my case would be presented to the board,” recalls Richard. Meanwhile, Becky worked with Anne Anthony, Cochlear’s Sr. Manager Regional Reimbursement for the Central region, to gather and provide supporting literature and documentation and was able to present this information to the board members in the review of Richard’s case. OMS received notification in November that the board approved the cochlear implant. In addition, they committed to removing the age restriction on medically necessary cochlear implants for all health plan members.
“I am so grateful that they understood that receiving a cochlear implant would greatly impact my life, both professionally and personally. Not only did they approve my surgery but they changed the plan for all employees starting January 2019. I honestly believe that all things happen for a reason. If this wouldn’t have happened, then maybe there wouldn’t have been a change in the policy and others wouldn’t get the chance to improve their quality of life,” remarked Richard.
As demonstrated by Richard’s story, OMS will work with recipients, professionals, HR representatives and employers to assist in providing information to obtain approvals which can sometimes lead to a policy change. Let us know how Cochlear’s reimbursement services have worked for you – send us your story! email@example.com
For more information on services provided by OMS, visit our webpage or contact via email at OMS@Cochlear.com.
About our guest author:
Nicole Craig is the Senior Manager of Managed Care and Market Access for Cochlear Americas. She oversees OMS and managed care contracting for Cochlear’s external DME replacement parts and accessories.
Information provided by Cochlear Americas regarding insurance coverage or reimbursement is provided as guidance only and is not intended as reimbursement or legal advice. Cochlear Americas makes no representation or warranty regarding such information or its completeness, accuracy, fitness for a particular purpose, or that following such guidance will result in any form of coverage or reimbursement from any insurer. Information presented is subject to change at any time. 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 needs. In all cases, products or services billed must be medically necessary, actually performed and appropriately documented in the medical record.