Tag: Hunter Gerhart

With 12 new CPT codes taking effect as 2026 begins, hearing care practices must prepare for a complex transition that promises to better reflect modern audiology but may initially bring financial and administrative challenges. By Melanie Hamilton-Basich A long-anticipated update to the current procedural terminology (CPT) codes used for billing and claims is set to take effect, promising a system that more accurately reflects the advanced, technology-driven services that have become standard in modern hearing healthcare. The 12 new CPT codes for audiology will cover hearing aid candidacy, hearing aid selection, hearing aid and assistive device fitting, follow-up, verification, and electroacoustic analysis. CPT codes 92590-92595 will no longer be applicable. The changes aim to close the gap between an outdated coding structure and the daily realities of today’s practitioners. This modern reworking of audiology CPT codes will help align billing practices with the sophisticated work involved in fitting and managing digital, Bluetooth-enabled hearing aids and other advanced technologies. For many, it’s a welcome and overdue evolution that better values the comprehensive care that hearing care professionals provide. “I think finally the coding is catching up to what audiologists do on a daily basis,” says Hunter Gerhart, AuD, who oversees clinical care and operations for all hearing clinic locations across several states as director of audiology at Livingston Hearing Aids Centers. “A lot of the codes that we were utilizing were codes that were developed when analog hearing aids were routinely being fit. And we have moved a long way from analog. Even today, digital hearing aids are much more advanced than they were five and 10 years ago.” However, with progress comes the practical challenge of implementation. An effective transition requires careful preparation, staff training, and proactive communication to navigate a complex payer landscape. All of this will help hearing care practices navigate the financial and administrative hurdles that come with such a widespread change. https://hearingreview.com/practice-building/practice-management/medicare-insurance/know-the-facts-charging-medicaid-patients Codes to Match Modern Audiology The outgoing CPT codes were created in an era that predates the common use of today’s hearing aid technology. As Gerhart notes, what was once a premium feature is now standard. “When I first started practicing in 2018… there were hearing aids available that had Bluetooth. And if you had a patient who really wanted Bluetooth, well, then you’d have to choose that model. But now Bluetooth is standard in pretty much every hearing aid,” he explains. The previous codes failed to take into account the amount of time and effort required from HCPs for these advancements. “The codes we had didn’t always reflect all of the additional work that we were doing for today’s hearing aids and all of the pairing and other technology that is available,” Gerhart adds. “And so I think it’s an exciting time for audiologists as we have these new codes that can better identify and distinguish what we’re doing with our patients.” The new CPT code structure will also group together many tasks that are closely associated with each other instead of billing for them separately, notes Adam Nager, founder and CEO of Quest National Services, a national revenue cycle management firm. “The new codes combine services that were previously billed with several codes over two visits,” Nager says. He points to the new CPT code 92628, which will now include the evaluation, review of audiology function tests, assessment of hearing needs, and counseling with a report. This bundling is designed to streamline the billing process but also introduces new complexities that staff must understand to avoid errors. A Fragmented Payer Landscape While the new codes are available starting in January, the transition is unlikely to be seamless. The primary hurdle lies in the fragmented nature of the U.S. healthcare system, where countless different payers—from Medicare and Medicaid to various private insurance companies—operate on their own timelines and with their own policies. “Anytime that you introduce new billing codes, that can create some hiccups,” Gerhart cautions. “It’s up to the individual payers how they are going to implement these codes and when they’re going to implement these codes. The codes are going to be available, but it doesn’t necessarily mean that all of the insurance companies and payers will be up to speed and ready for these codes to be implemented on January 1st.” This potential lag creates a significant risk for practices. “If coded incorrectly, claims will result in denials,” Nager states plainly. He expects that the initial phase will be marked by uncertainty. “I anticipate there will be a ton of confusion, with one of the most important questions being what the carriers will allow when you only bill one code versus previously billing three to five,” he says. Gerhart shares this concern, predicting a short-term increase in administrative burdens. “I foresee in the first quarter of 2026 there may be increased denials from insurance companies where we’re having to then go back and have these claims looked at again or reconsidered,” he says. “I’m hopeful that there will be minimal impact or disruption, but that really requires all of the payers that an audiologist bills to have these codes loaded into their system and to have made a determination already if these are reimbursable or not.” Steps for a Smooth Transition To mitigate these risks, experts urge practices to be proactive. The first and most critical step is education. Both Nager and Gerhart emphasize the importance of understanding the new codes and how to use them at the outset, and taking advantage of available resources to do so. “Get very familiar with the definitions and the requirements of the new codes, both for documentation and all that needs to be completed in order to build that code,” urges Gerhart. Many payers and professional audiology associations are providing resources to explain how the new codes will differ from the old ones. In addition, many office management system companies are providing resources specific to their platforms explaining exactly how the changes to CPT codes will be reflected in their billing systems and how to navigate the differences. https://hearingreview.com/practice-building/office-services/office-management-systems/practice-management-software-roundtable-ai-automation-and-analysis And of course, you can go straight to the source and read and reference the current CPT Professional Edition, published by the American Medical Association. Beyond general education, practices must understand the specific structural changes. “Insurance carriers may or may not be ready for the new codes in January, but providers should be,” Nager says. He highlights the importance of obtaining a “crosswalk” document showing what today’s codes could be next year. “Each clinic should make sure they have a copy of the crosswalk and understand the new codes and, ultimately, what is included with each of the revised codes, as some services will now be combined into one code,” he says. It is equally important, he adds, for staff to “be aware of the codes that are being removed as well as those that are getting added.” Direct communication with payers is another non-negotiable step. Practices cannot assume that all payers will adopt the new codes or reimburse them in the same way. “It’s important to look at your individual contracts with the payers that you are in network with to determine, ‘Is this the code that I should be using?’” Gerhart says.. “I think a lot of it is reaching out to provider reps with the insurance companies that you’re contracted with to see how that company plans to incorporate said codes, but also what your reimbursement is going to be.” Coordinating Changes Across the Practice For businesses with multiple locations, ensuring a consistent and coordinated rollout is paramount. Nager suggests a structured approach. “The best thing to do is treat the business, if there are multiple locations, as a franchise,” he says. “Every franchise should have documented operating processes… Get everyone on the same page by implementing documented structure and have that documented structure signed off on by leadership within each of the clinics.” Gerhart’s organization, which includes 120 locations, is taking a similar approach with formal training. “On January 2nd, all of our providers for the first hour of the day are going to be attending a virtual meeting,” he says. “So before they even see patients in January, they will know all of the updated codes and the requirements.” This training extends to a fundamental shift in documentation, as many of the new codes are time-based. “Audiology as a whole, we have not had a lot of experience with time-based codes,” Gerhart notes. “I think that there may need to be a shift in how audiologists document the procedures and the services that they’re providing to better document this time component.” This includes tracking not only direct, face-to-face clinical care but also indirect time spent on tasks like report writing and appointment preparation. “We may need to shift our mindset in how we document just to substantiate the time that’s spent doing the tasks that we’re performing,” he adds. Long-Term Outlook Despite the initial administrative hurdles, the long-term outlook for the new CPT codes is optimistic. A coding structure that better represents the value of audiological services could lead to improved coverage and reimbursement, ultimately benefiting both providers and patients. Gerhart is particularly hopeful about the impact on aftercare, especially for patients who change providers. Historically, when a patient purchased a hearing aid with a bundled aftercare package and then moved, they would have to pay out of pocket for follow-up services at a new clinic because insurance often did not cover it. “Most insurance companies don’t reimburse for that because we haven’t had a CPT code or a HCPC code that accurately describes what we’re doing in these follow-up appointments,” he explains. “I’m hopeful that with the addition of these codes that some payers will get on board with reimbursing them so that patients can have a more seamless experience as they transition their hearing care to a different provider.” Although it will take some adjustment, ultimately, the 2026 CPT code update lays the groundwork for a system that better recognizes the scope and complexity of modern audiology—a change that many would agree is well worth the effort. Featured image: Woman sitting at computer in medical office. Photo: ID 184050333 © Syda Productions | Dreamstime.com

Tag: Hunter Gerhart

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