By: Peyton Stephens, MS CCC-SLP, LSLS Cert. AVT, TSHA State Advocate for Reimbursement (STAR) and Kelsey Hatton, AuD, CCC-A, TSHA Vice President for Audiology
Beginning January 1, 2026, a new set of 12 CPT® codes were introduced to describe the professional services audiologists provide for hearing device-related care. These codes replace the long‑standing hearing aid service codes 92590–92595. As these are new codes that will need billing rates for Texas Medicaid payments, the Texas Health and Human Services (HHSC) Provider Finance Department (PFD) Acute Care has indicated that they are reviewing rates for use.
What To Know About the Rate Review
- The proposed effective date for these rates is January 1, 2026.
- HHSC has posted rate hearing packets that indicate the proposed rates for these codes.
How You Can Comment
The HHSC Provider Finance Department (PFD) Acute Care will hold a Public Rate Hearing on March 3 at 9 a.m. CST. The hearing will be available both in-person and online. During this time, constituents, organizations, and business can provide testimony and/or submit written comments. Written comments may be submitted in addition to or instead of oral testimony until 5 p.m. CST on March 3.
If you’d like to register for the online portion of the hearing, you can register at https://register.gotowebinar.com/register/7078408922066691675. During registration, you can sign up to provide testimony.
If you’d like to attend in-person, the hearing will be held at the following address:
Health and Human Services Commission, North Austin Complex, Public Hearing Room 1.401, 1.402, 1.403 & 1.404
4601 W Guadalupe Street, Austin, Texas 78751
Please note: When you register, the system will list the event as running from 9 a.m. to 5 p.m. CT. In practice, the event begins at 9 a.m. and will conclude once all testimony has been heard. If you plan to provide testimony, please be aware that in‑person testimony will begin at 9 a.m., followed by virtual testimony in the order in which individuals registered. We recommend joining at 9 a.m., as the event may end early if there are only a few individuals signed up to provide testimony.
For additional questions regarding the hearing or the rates, please contact PFD Acute Care at PFDAcuteCare@hhs.texas.gov.
Texas Speech-Language Hearing Association (TSHA)'s Response
TSHA’s Advocacy and Audiology teams are rapidly reviewing these rates as we prepare to submit a comment. Below is a preliminary assessment of the rates:
Recognition of Improved Code Structure
- We are encouraged that the new CPT code structure explicitly incorporates time, bringing audiology coding more in line with the autonomy and flexibility used by physicians, such as Ear, Nose and Throat (ENT) physicians.
Need for Stronger Reimbursement Rates
- The proposed per‑minute values fall far below the true cost of audiologist labor in Texas. Current salary benchmarks translate to hourly wages significantly higher than what the proposed rates would cover.
- As written, the rates do not meet the basic cost of employing licensed clinicians—let alone overhead, compliance requirements, or high standards of care.
- Several new codes require the use of advanced equipment such as real‑ear verification systems (e.g., Audioscan Verifit, costing $15,000–$18,000). We believe these rates should better recognize these overhead costs.
Specific Recommended Adjustments
- We strongly recommend an adjustment to the proposed CPT 92636 rate so that it is:
- At least double the previous V5014 rate or aligned with historical rates for 92592/92593.
- Alternatively, reimbursement should be structured to represent approximately half of the value assigned to CPT 92634 (60-minute hearing aid fitting).
- This approach aligns Texas Medicaid with national CMS RVU‑based methodologies and more accurately represents the time and professional skill required.
Risk to Network Adequacy
- Inadequate reimbursement places providers in financially unsustainable situations.
- This may force clinics to reduce or discontinue Medicaid participation, directly impacting access to high‑quality hearing care.
- Insufficient rates can worsen statewide network adequacy challenges and limit care options for Medicaid beneficiaries.
Our Request to HHSC
- We respectfully urge HHSC to revise the proposed rates so they better align with provider effort, equipment investment, regulatory expectations, and national reimbursement standards.
Questions and Comments
As you, as members of TSHA, also review these rates, we welcome your feedback. TSHA is working to draft a public comment, which will be submitted by the March 3 deadline. Please send any of your comments or data to us at staff@txsha.org.