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. To assist Members, we have created the following summary of the changes that are relevant to otolaryngology-head and neck surgery. If you have any questions regarding CPT code changes for 2016, please contact the Health Policy team.

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 Editorial Panel, for the coming year. In addition, CMS includes new, or updated, values (also known as relative value units [RVUs]) for medical services that 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 services 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.

New Codes

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 Members’ 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 that were reviewed included: caloric vestibular testing codes; laryngoscopy family of codes; and submucosal ablation of the tongue base.