VEP Payments and Other Testing

At our Pediatric Practice Management and UC event 2 weeks ago (time flies!), the perennial question about whether practices are paid for their use of the VEP machine and CPT code 95930.  It seems that just under 10% of PCC’s practices us a machine like the one from Diopsys while a smaller number use a machine like the one from PediaVision (CPT code 99174).

Igor ran the numbers and they are unequivocal:  our clients get paid for this work.  The problem is that we can’t properly measure when practices are not being paid and, therefore, stop performing these tests.  Let’s look at the data…

 

 CPT Code  Description  PCC Client Volume  AVG Charge  AVG Payment
 99174  Ocular Photoscreening  ~3%  $34.29  $19.63
 95930  VEP  ~9%  $155.73  $94.14
 92587  OAE Hearing Test  ~25%  $99.11  $56.84

Thus, approximately 9% of our clients recorded a 95930 procedure and charged, on average, $155.73 and were paid $94.14.  This seems like good news and feedback.  The problem, as I noted above, is that the practices who are not being paid don’t show up here.  They simply stop doing the tests.

What I find really interesting is the use of and different results for the various CPT modifiers that were used for both the VEP and OAE tests.  Most, but not all, of our clients use some combination of -52, -25, -53, and -59 modifiers on these codes.  The -53 and -59 are the only ones with real volume.

The -53 modifier is for a “Discontinued Procedure” such as when the child is too wiggly for you to perform the test.  The OAE code (92587-53) dropped from $56.84 in payment to $33.47.  The VEP dropped from $94.14 to $64.48.  I’d say that this makes some sense.

The -59 modifier, meanwhile, is for a “distinct procedural service.”  This is the cousin of the -25, which is for a distinct E&M service for the same day.  The -59 is for procedures instead.  When used, the OAE jumps to  $62.04 and the VEP jumps to $103.40.

I didn’t look to see which payers preferred which modifiers, I’ll leave that as an exercise for reader input.

No, PCC does not endorse any of these products nor do we get favors for this research.

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