As the medical community has come to expect, part of the annual rulemaking process conducted by the Centers for Medicare and 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.

ENT CPT Codes Changes 2015 for Billing by AMA RUC

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 2015.

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 2015:

ENT CPT Codes Changes 2015 for Otolaryngology Billing

InCY 2015, a new CPT code and/or deleted CPT codes will be announced, including:
  1. 1 New ENT CPT Code (43180) to report Endoscopic Zenker's Diverticulum
  2. 3 Deleted ENT CPT Codes (69400, 69401, and 69405) for Eustachian Tube
  3. An unlisted CPT code (69799) is recommended to report the work of 69400 or 69405
  4. For CPT Code 69401, the appropriate Evaluation and Management (E&M) office visit code is recommended.

ENT CPT Codes Reviewed by AMA RUC in CY 2014

In addition to the creation of several new CPT codes for 2015, 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 2015 final rule.

Members should be prepared for modified relative value units for some, or all, of these procedures in CY 2015. It is critical to note that once the final MPFS is issued by CMS, typically on or about 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:
  1. 92541 Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording
  2. 92542 Positional nystagmus test, minimum of 4 positions, with recording
  3. 92543 Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes 4 tests), with recording
  4. 92544 Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording
  5. 92545 Oscillating tracking test, with recording
For the following ENT CPT codes , only practice expense inputs are reviewed by the RUC in 2014, physician work was not surveyed or discussed for these codes.
  1. 10021 Fine needle aspiration; without imaging guidance
  2. 30903 Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method
  3. 30905 Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial
  4. 31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium (eg, balloon dilation), transnasal or via canine fossa
  5. 31296 Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ostium (eg, balloon dilation)
  6. 31297 Nasal/sinus endoscopy, surgical; with dilation of sphenoid sinus ostium (eg, balloon dilation)
  7. 41530 Submucosal ablation of the tongue base, radiofrequency, 1 or more sites, per session
  8. 30300 Removal foreign body, intranasal; office type procedure
  9. 30906 Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; subsequent
  10. 40804 Removal of embedded foreign body, vestibule of mouth; simple
  11. 42809 Removal of foreign body from pharynx
  12. 69200 Removal foreign body from external auditory canal; without general anesthesia
  13. 69220 Debridement, mastoidectomy cavity, simple (eg, routine cleaning)
  14. 92511 Nasopharyngoscopy with endoscope (separate procedure)

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