Billing and Coding Updates

Insurance Update

1. CROS – BiCROS:

The Center for Medicare and Medicaid Services (CMS) has updated certain HCPCS codes effective January 1st relating to CROS and BiCROS billing. Please make sure to use these new codes for all lines of business, including Medi-Cal.

Effective June 1st, we will only be providing BiCROS Hearing Aids as an option to all patients and no longer CROS, so your primary billing code is V5221 going forward.

2. X & Z Procedure Codes:

Medi-Cal had previously announced that effective June 1st, they would be converting their X & Z procedure codes to the standardized National 9xxxx Procedure Codes. Their website now indicates that until further notice, the conversion date has been postponed. However, the crosswalk for the primary codes they have identified that we use are as follows;

When obtaining an Auth, if they do not recognize the X code you are requesting, please use the applicable 925XX code.

3. Billing Packages:

Effective June 3rd, please discontinue using the “ZZ” code type in the portal to submit billing packages and revert back to using the standard “Billing” Hearing Aids / Testing ticket types.

4. Medi-Cal Loss and Damage

For Medi-Cal lines of business, other than LA CARE, when submitting a claim for Loss and Damage, please use the new “Loss and Damage - Medi-Cal Lines of Business” V5298 line item under “Hearing Aid Services, Repairs and Warranties” on the Encounter Form. You are required to obtain an Auth for this service from the Plan and submit that with your Billing Package. Enter the Charge for the service.

For LA Care please use the new “Loss and Damages – LA CARE” line item under “Hearing Aid Services, Repairs and Warranties” on the Encounter Form. Enter the Charge and HA specific code next to the “RB”.

Please make sure to use the most current encounter forms as of June 1st from Serendipity Resources.