CPT Changes for 2016: What ENTs Need to Know
There are several Current Procedural Terminology® (CPT) code changes for 2016 applicable to Otolaryngologist – Head and Neck Surgeons. Below is a summary of these changes. If you have any questions regarding CPT code changes for 2016, please contact the Health Policy team.
Coming Soon: Official guidance from the Academy and the AMA on coding for drug-eluting stents (CPT 0406T and 0407T) and how to use the updated cerumen removal code (CPT 69209). When the guidance is released an announcement will be placed in the News.
What ENTs Need to Know
As the medical community has come to expect, part of the annual rulemaking process conducted by the Centers for Medicare & Medicaid Services (CMS) includes the annual issuance of new and modified CPT codes, developed by the American Medical Association's (AMA) Current Procedural Terminology (CPT) Editorial Panel, for the coming year. In addition, CMS includes new, or updated, values (also known as relative value units (RVUs)) for medical services which have undergone review by the American Medical Association's Relative Update Committee (AMA RUC). CMS has the discretion to accept the RUC's RVU recommendations for physician work, as well as recommendations for direct practice expense inputs, or it may exercise its administrative authority and elect to assign a different value, or practice expense inputs, for medical procedures paid for by Medicare. The final value, as determined by CMS, is then publicly released in the final Medicare Physician Fee Schedule (MPFS) rule for the following calendar year.
The Academy is an active participant in both the AMA RUC valuation of otolaryngology-head and neck services, and the CMS annual rulemaking processes. As part of those efforts, we want to ensure members are informed and prepared for key changes to CPT codes and valuations related to otolaryngology-head and neck surgery serviced for CY 2016. The following outlines a list of coding changes, including new and revised CPT codes, as well as codes which were reviewed by the AMA RUC and could have modified Medicare reimbursement values for 2016:
In CY 2016, the following changes were made to CPT codes:
- 0406T, Nasal endoscopy, surgical, ethmoid sinus, placement of drug eluting implant; and
- 0407T, Nasal endoscopy, surgical, ethmoid sinus, placement of drug eluting implant; with biopsy, polypectomy or debridement, were created.
- 92543, Caloric vestibular test, was deleted.
- 92537, Caloric vestibular test with recording, bilateral; bithermal, was created
- 92538, Caloric vestibular test with recording, bilateral; monothermal, was created
- 92270, Electro-oculography with interpretation and report, new parenthetical references were added
- 92597, 92605, and 92607, new parenthetical references were added
- 69209, Removal impacted cerumen using irrigation/lavage, unilateral, was created.
(CPT Assistant article provides clarification on coding compared to CPT 69210 and E/M services)
Codes Reviewed by the AMA RUC in CY 2015
In addition to the creation of several new CPT codes for 2016, a number of existing CPT codes relating to otolaryngology were reviewed by the AMA RUC, and their RUC approved values were submitted to CMS for final determination for the CY 2017 final rule. Members should be prepared for modified relative value units for some, or all, of these procedures in CY 2017. It is critical to note that 2016 is the first year where CMS will begin publishing proposed values within the MPFS Proposed rule, typically published the first week of July. The Academy will monitor the recommended values for these services and comment on member's behalf. Final values will be released within the final MPFS which is issued by CMS typically around November 1 of each year. Upon receipt, Academy health policy staff will summarize the final rule and alert members to any critical changes in reimbursement for any of the following medical procedures. Services which were reviewed include:
- 9254X3- caloric vestibular test with recording, bilateral; bithermal
- 9254X4- caloric vestibular test with recording, bilateral, monothermal
- 31575- Laryngoscopy, flexible; diagnostic
- 31576- Laryngoscopy, flexible; with biopsy(s)
- 31577- Laryngoscopy, flexible; with removal of foreign body(s)31578- Laryngoscopy, flexible; with removal of lesion(s), non-laser
- 315X1 - Laryngoscopy, flexible; with ablation or destruciton of lesion(s) with laser, unilateral
- 315X2 - Laryngoscopy, flexible; with therapeutic injection(s) (eg, chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral
- 315X3 - Laryngoscopy, flexible; with injection(s) for augmentation (eg, percutaneous, transoral), unilateral
- 31579- Laryngoscopy, flexible or rigid telescopic, with stroboscopy
- 41530- Submucosal ablation of the tongue base, radiofrequency, 1 or more sites, per session
CPT 0406T, 0407T