By guest author: Anne Anthony
Staying current on coding changes is important for all providers to ensure accuracy of both reporting of claims and payment for services. In our ongoing commitment to provide exceptional service, we want to provide you with a summary of the HCPCS (Healthcare Common Procedure Coding System) code updates related to auditory osseointegrated device sound processors. As of January 1, 2018, providers are required to bill two HCPCS codes for any Baha® 5 system replacement sound processor – HCPCS codes L8691 and L8694.
Why has CMS (Centers for Medicare and Medicaid Services) added a new code? The new code delineates integral components in the sound processor device. CMS assigned a new code, HCPCS code L8694, to represent the transducer/actuator component within the system. HCPCS code L8691 remains an active code and its description has been revised to exclude the transducer/actuator component of the external sound processor. The transducer/actuator components are integral parts of each external sound processor, and they often cannot be separately replaced based on the configuration. For example, the transducer/actuator is only separately replaceable in the Baha® 5 SuperPower system due to the configuration. Therefore, when a recipient requires a replacement sound processor system, the provider should utilize both HCPCS codes to represent the device. The illustration below depicts how the transducer/actuator components are housed in each version of the available Baha® 5 system sound processors.
With any code revision, questions arise about the impact to payment. With these revisions comes an update to the Medicare DMEPOS* fee schedule. CMS assigned rates to each specific HCPCS code, allowing the current total fee for both codes to remain comparable to that of the single code in previous years. The table below provides the current Medicare national average rate for these codes. Cochlear recommends providers contact any non-Medicare payers to inquire into updates for HCPCS codes and fee schedules.
For the latest information, visit www.Cochlear.com/US/Professionals and click on Resources-Reimbursement Solutions-Coding and Billing Support for Professionals/Facilities or call the Cochlear Coding Support Hotline 1 800 587 6910.
About our guest author:
Anne Anthony is one of three geographically-based hearing implant reimbursement experts available to assist you with coding, payment, payer coverage, contracting, and other reimbursement related challenges. Anne’s contact information, along with that of her colleagues and a more detailed description of the reimbursement support offered by Cochlear’s Regional Reimbursement team, can be found on the Reimbursement Support page of Cochlear’s US Professional Resources Website. Please do not hesitate to reach out to the Reimbursement Manager associated with your geography for reimbursement assistance or for questions related to this article. Cochlear offers coding assistance through the Coding Support Line accessible by calling 1-800-587-6910 between the hours of 8 AM – 3 PM Mountain time zone or via email at firstname.lastname@example.org. For pre-surgical insurance support, OMS is available to assist with pre-authorizations and appeals and can be reached at 1-800-633-4667 option 4.