The Audiology Patient Choice Act already has momentum in the 116th Congress with commitments from lawmakers in both parties to help enact it so that Medicare patients can have direct access to the audiology services that they need, and so that audiologists can be appropriately recognized within the Medicare system.
We hope and expect an early re-introduction in both the House of Representatives and the Senate and we need your help. There are more than 100 new members of Congress entering the 116th Congress, which began on January 3, 2019.
These freshmen legislators will all need to be educated on the Audiology Patient Choice Act (APCA) and its merits as soon as possible—and we will also need to reconnect with incumbent lawmakers as well. To that end, ADA is creating collateral packets and other resources including patient information brochures and legislative support postcards to send to Congress during the first quarter of 2019. Please contact Adam Haley at ahaley@audiologist.org to order yours today.
Also, please contact Adam Haley at ahaley@audiologist.org to sign up for the ADA Advocacy Listserv where we will be able to broadcast and share specific information about plans and initiatives to advance APCA in the 116th Congress (members only, please).
Please contact Carrie Puyear at cpuyear@audiologist.org to volunteer. All ADA members in good standing are eligible and encouraged to volunteer for ADA committee service.
The Centers for Medicare and Medicaid Services (CMS) has created a new code set related to CROS/BICROS technologies. These codes will go into effect on January 1, 2019.
A CROS system is where a patient wears a “hearing aid,” functioning as a receiver, on the normal hearing ear and a “hearing aid,” functioning as a transmitter, on the “unaidable” ear. A BICROS system is where a patient wears a hearing aid/receiver on the better hearing ear and a “hearing aid,” functioning as a transmitter, on the “unaidable” ear. The hearing aid and “hearing aid” receivers and “hearing aid” transmitters can be in-the-ear (ITE), in-the-canal (ITC), and/or behind-the-ear (BTE) types/styles and the patient can be fit with different types/styles in each ear. The new codes will now reflect these options.
PLEASE NOTE: Before utilizing this new code set, please consult your payer fee schedules, agreements, and websites. Some payers, especially State and Managed Medicaid programs, may not recognize the new code set. THE EXISTENCE OF A CODE IS NOT A GUARANTEE OF THIRD-PARTY COVERAGE OR PAYMENT NOR IT IS A GUARANTEE OF AN INCREASED ALLOWABLE RATE.
Below please find select tables that outline the new, revised, or remaining existing codes, their official 2019 descriptions, their official 2018 descriptions, when applicable, and how these codes are applied to clinical situations.
V5171 Hearing aid, contralateral routing device, monaural, in the ear (ITE) The patient has an existing hearing aid or CROS receiver that was dispensed on a previous date of service; this code represents a new or replacement ITE transmitter for the “unaidable” ear.
V5172 Hearing aid, contralateral routing device, monaural, in the canal (ITC) The patient has an existing hearing aid or CROS receiver that was dispensed on a previous date of service; this code represents a new or replacement ITC transmitter for the “unaidable” ear.
V5181 Hearing aid, contralateral routing device, monaural, behind the ear (BTE) The patient has an existing hearing aid or CROS receiver that was dispensed on a previous date of service; this code represents a new or replacement BTE transmitter for the “unaidable” ear.
V5211 Hearing aid, contralateral routing system, binaural, ITE/ITE The patient is receiving a new CROS/BICROS system (both the transmitter and hearing aid/receiver) on the same date of service; this code represents a system where both ears have an ITE device.
V5212 Hearing aid, contralateral routing system, binaural, ITE/ITC	 The patient is receiving a new CROS/BICROS system (both the transmitter and hearing aid/receiver) on the same date of service; this code represents a system where one ear has an ITE device and one ear has an ITC device.
V5213 Hearing aid, contralateral routing system, binaural, ITE/BTE	 The patient is receiving a new CROS/BICROS system (both the transmitter and hearing aid/receiver) on the same date of service; this code represents a system where one ear has an ITE device and one ear has a BTE device.
V5214 Hearing aid, contralateral routing system, binaural, ITC/ITC	 The patient is receiving a new CROS/BICROS system (both the transmitter and hearing aid/receiver) on the same date of service; this code represents a system where both ears have an ITC device.
V5215 Hearing aid, contralateral routing system, binaural, ITC/BTE	 The patient is receiving a new CROS/BICROS system (both the transmitter and hearing aid/receiver) on the same date of service; this code represents a system where one ear has an ITC device and one ear has a BTE device.
V5221 Hearing aid, contralateral routing system, binaural, BTE/BTE	 The patient is receiving a new CROS/BICROS system (both the transmitter and hearing aid/receiver) on the same date of service; this code represents a system where both ears have a BTE device.
V5190 Hearing aid, contralateral routing, monaural, glasses Hearing aid, CROS, glasses The patient is receiving a new CROS device housed in eyeglasses; this code represents the eyeglass CROS device in the monaural configuration.
V5200 Dispensing fee, contralateral, monaural	 Dispensing fee, CROS The patient is receiving a new CROS device; this code represents the dispensing fee surrounding the fitting of this device.
V5230	 Hearing aid, contralateral routing system, binaural, glasses Hearing aid, BICROS, glasses The patient is receiving a new BICROS device housed in eyeglasses; this code represents the eyeglass device in the binaural configuration.
V5240 Dispensing fee, contralateral routing system, binaural Dispensing fee, BICROS The patient is receiving a new BICROS device; this code represents the dispensing fee surrounding the fitting of this device.
Please note: The dispensing fee is the facility fee surrounding the evaluation, selection, ordering, programming, and fitting of a CROS/BICROS device that is not represented by another CPT or HCPCS code. Some payers, specifically State and Managed Medicaid programs, consider the dispensing fee code to represent the fitting and orientation of the device (V5011).
Please note: Some payers, specifically State and Managed Medicaid programs, may have difficulty transitioning to the new code set. Practices may need to file appeals, especially at the outset of 2019, detailing the replacement codes.
If you have specific questions, please contact Kim Cavitt, AuD at kim.cavitt@audiologyresources.com or 773-960-6625. This one-on-one professional guidance is a value-added benefit of ADA membership.
Due to unprecedented demand, ADA is now taking applications for the 4th and 5th Mastermind Groups, including one group, by request, that will meet during workday hours.
ADA is pleased to facilitate Audiology Mastermind Groups for its members through its GotoMeeting web platform. Group leaders will be provided access to set up and use the virtual meeting space and each Mastermind group will have complete autonomy. The meetings will be exclusive to the audiologist participants. ADA staff will be available to contact for technical troubleshooting if needed but will not participate in the meetings.
Meeting discussions will be private and confidential to each group. Each Mastermind group will independently determine topics for discussion and the structure and frequency of the meetings. Each group will consist of 8 – 12 non-competing audiologists. ADA members only.
Please contact Carrie Puyear at cpuyear@audiologist.org for more information or questions.