Otolaryngology Coding Alert

Medicare says 95992 is a no-no.

The Epley maneuver is a simple but time- consuming treatment for a type of dizziness.

What happens: The Epley maneuver treats a form of vertigo (386.11, Benign paroxysmal positional vertigo or H81.1-, Benign paroxysmal vertigo in ICD-10) that is caused by small calcium carbonate stones that have moved from the vestibule of the inner ear into the semicircular canals, where your sense of balance rests. The stones stimulate nerves and cause a spinning sensation, nausea, and unsteadiness.

In the Epley, the patient’s head is maneuvered so the calcium crystals roll out of the sensing tube and into another inner chamber of the ear, from which the body can absorb them.

Report 95992 (Canalith repositioning procedure[s] [e.g., Epley maneuver, Semont maneuver], per day) to describe the Epley. Medicare, however, considers the code a bundled service.

95992 Reimbursement is Questionable

For years, audiologists have performed Epley maneuvers on patients who experience dizziness. But under Medicare, audiologists can’t get paid for Epley. The Otolaryngology Head and Neck Surgery (AAO-HNS) website states, “Medicare will not reimburse audiologists for performing Canalith repositioning because it is not a diagnostic test.”

Medicare limits audiologists’ scope of practice to audiological diagnostic tests. Since Medicare requires audiologists bill under their own NPIs, their involvement with a patient is clear to the payer.

Don’t miss: Payers have denied 95992 claims “for not being performed by a qualified provider.” In these cases, make sure an audiologist is not doing the Epley maneuvers in your office.

Follow This Sound Advice

If the local contractor (Medicare or non-Medicare) LCD has specifically stated that Epley is part of E/M and should not be reported separately, then the practice should not do so. If the contractor does not have an Epley LCD, either report the code or write a query to the carrier requesting written verification of how to report the two services.

Unless the carrier is very clear, CPT^® rules should apply. If your practice needs to track Epleys but must count them as part of E/M, create an internal code with a value of $0.