Oregon Administrative Rules
Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS
Division 129 - SPEECH-LANGUAGE PATHOLOGY, AUDIOLOGY AND HEARING AID SERVICES
Section 410-129-0240 - Audiologist and Hearing Aid Procedure Codes
Universal Citation: OR Admin Rules 410-129-0240
Current through Register Vol. 63, No. 9, September 1, 2024
(1) Inclusion of a CPT/HCPCS code on the following does not mean that a code is covered. Refer to OAR 410-120-1280 and OAR 410-141-3565 for information on coverage.
(2) The following are Audiologist and hearing aid procedure codes:
(a) 92553 - Pure tone audiometry, air and
bone, limited to one per calendar year;
(b) 92557 - Comprehensive audiometry
threshold evaluation and speech recognition includes pure tone, air and bone,
and speech threshold and discrimination. Also includes testing necessary to
determine feasibility of amplification;
(c) 92590 - Hearing aid examination and
selection, monaural may include sound field speech reception tests, speech
discrimination tests, determination of appropriate style of hearing aid and to
determine if the ear may receive amplification;
(d) 92591 - Hearing aid examination and
selection, binaural may include sound field speech reception tests, speech
discrimination tests, determination of appropriate style of hearing aid, and
which ear may receive amplification;
(e) 92592 - Monaural hearing aid inspection
and battery check. The aid is cleaned, and the power and clarity are checked
using a special stethoscope, which attaches to the hearing aid.
(f) 92593 - Binaural hearing aids inspection
and battery check. The aids are cleaned, and the power and clarity are checked
using a special stethoscope, which attaches to the hearing aids.
(g) V5261 - Hearing aid, digital, binaural
and behind the ear requires Prior Authorization (PA);
(h) V5011 - Fitting, orientation, checking of
hearing aid includes adjusting aid to the wearer, instructions to wearer, and
follow-up care, and requires PA prior to provision of services;
(i) V5275 - Ear impressions made to obtain a
hearing device specified for the individual, each.
(j) V5160 - Hearing aid dispensing fee,
binaural, requires PA prior to providing services;
(k) V5181 - Hearing aid, contralateral
routing device, monaural, behind the ear (bte);
(l) V5200 - Hearing aid dispensing fee,
contralateral, monaural, requires PA prior to providing services;
(m) V5240 - Hearing aid dispensing fee, two
devises, contralateral routing system, binaural, requires PA prior to providing
services;
(n) V5241 - Hearing aid
dispensing fee, monaural hearing aid, any type, requires PA prior to providing
services;
(o) V5110 - Body warn
hearing aid dispensing fee, bilateral.
(p) V5020 - The conformity evaluation is to
confirm that the hearing aid is meeting the needs of the patient.
(q) 95992 - Canalith repositioning, treatment
for vertigo, per day.
(3) Special otorhinolaryngologic services codes only apply to services for cochlear implants. These services include medical diagnosis evaluation by the otology physician:
(a) 92601 - Diagnostic analysis of cochlear
implant, patient under seven (7) years of age, with programming;
(b) 92602 - Analysis and reprogramming of
inner ear (cochlear) implant, younger than seven 7 years of age;
(c) 92603 - Diagnostic analysis of cochlear
implant, age seven (7) years or older, with programming; follow up
exam;
(d) 92604 - Analysis and
reprogramming of inner ear (cochlear) implant, age seven 7 years or
older;
(e) 92626 - Evaluation of
auditory rehabilitation status, first hour;
(f) 92627 - Each additional 15
minutes;
(g) 92630 - Auditory
rehabilitation; pre-lingual hearing loss;
(h) 92633 - Post-lingual hearing
loss;
(i) L8614 - Cochlear
device/system (only reimbursed to hospitals);
(j) L8615 - Headset/headpiece for use with
cochlear implant device, replacement;
(k) L8616 - Microphone for use with cochlear
implant device, replacement;
(l)
L8617 - Transmitting coil for use with cochlear implant device,
replacement;
(m) L8618 -
Transmitter cable for use with cochlear implant device, replacement;
(n) L8619 - Cochlear implant external speech
processor, replacement;
(o) L8621 -
Zinc air battery for use with cochlear implant device, replacement, each
(maximum of 420 batteries per 12 months);
(p) L8622 - Alkaline battery for use with
cochlear implant device, replacement, each (maximum of 420 batteries per 12
months);
(q) L8623 - Lithium ion
battery for use with cochlear implant device speech processor, other than ear
level, replacement, each (maximum of two rechargeable per 12 months);
(r) L8624 -Lithium ion battery for use with
cochlear implant device speech processor, ear level, replacement, each (maximum
of two rechargeable per 12 months);
(s) L7510 - Repair of prosthetic device,
repair or replace minor parts, requires PA prior to providing
services;
(t) L7520 - Repair
prosthetic device, labor component, for 15 minutes, requires PA prior to
providing services.
Tables referenced are available from the agency.
Statutory/Other Authority: ORS 413.042 & ORS 414.065
Statutes/Other Implemented: ORS 414.025 & ORS 414.065
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