MEDICARE REIMBURSEMENT FEES 2018

State:     

SAMPLE EXPLANATION OF BENEFITS (EOB'S)

The following explanation of benefits are samples of payments made by 3rd party payors in Florida. Please check with your local carriers regarding fee schedules and prior authorization requirements.

 

SAMPLE BILLING

 

 
SAMPLE VNG TEST # 1
CPT CODE UNITS  MODIFIER
92540 1 NONE
92537 1 NONE
92546 1 NONE
92547 1 NONE

 
SAMPLE VNG TEST # 2
CPT CODE UNITS  MODIFIER
92540 1 NONE
92537 1 NONE
92546 1 NONE
92546 1 76
92547 1 NONE

 

SAMPLE VNG / BALANCE PLATE TEST # 3
CPT CODE UNITS  MODIFIER
92540 1 NONE
92537 1 NONE
92546 1 NONE
92547 1 NONE
92548 1 NONE

 

SAMPLE VNG / BALANCE PLATE / NEUROCOGNITIVE TEST # 4
CPT CODE UNITS  MODIFIER
92540 1 NONE
92537 1 NONE
92546 1 NONE
92547 1 NONE
92548 1 NONE
96116 1 NONE
96118 1 NONE
99483 1 NONE

 

SAMPLE NEUROCOGNITIVE TEST
CPT CODE UNITS  MODIFIER
96116 1 NONE
96118 1 NONE
99483 1 NONE

 

SAMPLE BALANCE TEST

CPT CODE UNITS  MODIFIER
92548 1 NONE
97750 1 59

 

SAMPLE PHYSICAL THERAPY TREATMENT

CPT CODE UNITS  MODIFIER
97110 1 GP
97112 2 GP
97140 1 GP

 

SAMPLE OFFICE VISIT / EAR CLEANING

CPT CODE UNITS  MODIFIER
99212 1 25
69210 1 NONE

 

 

The following sample billings are intended to be a guide for complete tests and complete treatments by general protocols. Partial tests are occasionally performed and treatment lengths may vary, therefore, providers should pay careful attention to billing only for the above procedures performed. Additionally, there are different rules and different LCD’s from state to state and carrier to carrier, therefore, providers should check with their local carriers and their health care attorney regarding testing rules, as well as, all general billing rules for VNG testing.

 

 

CPT CODES FOR VNG TESTS

 

92537 - Caloric vestibular test with recording, bilateral; bithermal (i.e., one warm and one cool irrigation in each ear for a total of four irrigations)
(Do not report 92537 in conjunction with 92270, 92538), (For three irrigations, use modifier -52), (For monothermal caloric vestibular testing, use 92538)

92538 - Caloric vestibular test with recording, bilateral; monothermal (i.e., one irrigation in each ear for a total of two irrigations)
(Do not report 92538 in conjunction with 92270, 92537), (For one irrigation, use modifier -52), (For bithermal caloric vestibular testing, use 92537)

 

Note: CPT codes 92537 and 92538 may not be billed more than once on the same date of service. To report more irrigations than indicated in each code, consider using the modifier -22 to indicate an increased service. In those circumstances, clinicians should be prepared to provide justification for the increased service and why it was needed.

 

92540 - Basic vestibular evaluation, includes the following.

 

1. Spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording.
2. Positional nystagmus test, minimum of 4 positions, with recording.
3. Optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording.
4. Oscillating tracking test, with recording.

 

92541 -  Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording.

 

These nystagmus tests document and measure the inability of the eyes to maintain a static position as a result of peripheral, CNS or congenital abnormality.

 

92542 -  Positional nystagmus test, minimum of four positions, with recording.

 

These spontaneous nystagmus tests document and measure the inability of the eyes to maintain a static position when the head is in different positions. These tests are valuable in documenting and quantifying patient complaints of dizziness in certain situations or positions. Moreover, they are sometimes helpful in localizing the abnormality as CNS or peripheral.

 
92543 -  MEDICARE revised to 92537/92538 - Caloric vestibular test, each irrigation (binaural bithermal stimulation constitutes four tests), with recording.

 

The caloric tests evaluate the viability of the peripheral end organs by stimulating them with warm and cold water or air while the patient is in the dark. The resulting dizziness and nystagmus is taken as an index of the viability of the organ. This helps in evaluating the ability of the CNS to visually suppress inappropriate dizziness and nystagmus.

 
92544 -  Optokinetic nystagmus test, bidirecitonal, foveal or peripheral stimulation, with recording.

 

The optokinetic test documents and measures eye movements as the patients watches a series of targets moving simultaneously to the right and then to the left. The optokinetic mechanism is at work when the visual movement in one direction encompasses more than a single point.

 
92545 -  Oscillating tracking test, with recording.

 

The smooth pursuit test evaluates the ability of the patient to keep a moving visual target registered on the fovea. The patient watches a moving target as it moves back and forth in a smooth pendular fashion. The saccadic test evaluates the ability of the patient to find a moving target and tests certain CNS neural integrators.

 
92546 - Sinusoidal vertical axis rotational testing

 

This is a computerized test of the Vestibulo-Ocular Reflex (VOR), the neural mechanism that keeps a visual image registered on the fovea during head movement. It evaluates the three functional components of the VOR system: the peripheral end organ, the vestibular nuclei of the brain stem and the higher central vestibular connections. The test is accomplished by having the patient move their head in both the horizontal and vertical plane. This information is useful for evaluating patients with balance disorders.

 
92547 - Use of vertical electrodes or video in any of all of the above tests to record vertical eye movement counts as 1 additional test.
 
69210 - Cerumen Removal: Removal of impacted cerumen requiring instrumentation.
 

 

CPT CODES FOR POSTUROGRAPHY

 

92548 - Computerized Posturography

 

97750 - Physical performance test or measurement, with written report (Alternative Code)

 

CPT CODES FOR PHYSICAL THERAPY TREATMENT

 

97001 -  Initial Evaluation

 

92548 - Computerized Posturography

 

97750 -  Physical performance test or measurement, with written report

 

95992 - Canalith repositioning procedure, performed by therapy personnel, under a therapy plan of care, (usually performed by a physical therapist)


97110 -  Therapeutic procedure, 1 or more areas, each 15 minutes, therapeutic exercises to develop strength, endurance, range of motion and flexibility.


97112 -  Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and proprioception, each 15 minutes

 

97116 -  Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing), each 15 minutes

 

97140 -  Manual therapy techniques, 1 or more regions, each 15 minutes

 

CPT CODES FOR NEUROCOGNITIVE TESTING

 

96116 - Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report.

 

96118 - Interpretation of neuropsychological tests and/or integration by a physician

96119 - Neuropsychological testing administered by a technician

 

96120 - Neuropsychological testing, administered by computer, with qualified health care professional interpretation and report

 

99483 -  Assessment and care planning for patient with cognitive impairment