What is Canalith?
Canalith is a type of procedure aimed at helping individuals with vertigo or dizziness. The specific name of the condition often treated with Canalith is called
benign paroxysmal positional vertigo (BPPV). According to the Mayo Clinic, "BPPV occurs when tiny particles called otoconia in one part of your inner ear break loose and fall into the canals of your inner ear." [1]The Vestibular Disorder Association explains the image below noting that the "Otoconia migrate from the utricle, most commonly settling in the posterior semicircular canal (shown), or more rarely in the anterior or horizontal semicircular canals. The detached otoconia shift when the head moves, stimulating the cupula to send false signals to the brain that create a sensation of vertigo."
[2]
What are the Canalith Maneuvers?
The procedure involves a series of maneuvers of both the head and trunk. The two main maneuvers adopted by professionals are the Epley maneuver and the Semont-Liberatory maneuver. The procedure may last about 15 minutes and should be performed by a trained professional. Patients may experience some nausea during the maneuvers. Some patients are prescribed medications prior to the treatment to curb any potential nausea symptoms.
How is it billed?
Canalith is billed using CPT code 95992 (
Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day. [3] Regardless of the number of movements or repositioning, this code should only be billed once per day. This code was introduced and added to the American Medical Association (AMA) CPT Codes as well as the CMS Relative Value Unit (RVU) File in 2009.
Is it a covered service?
While Medicare includes this code in the RVU File, when this code first came out, Medicare considered it inclusive of an evaluation and management service or physical therapy service. In 2011, Medicare revised the guidelines to allow physical therapists to bill 95992.
[4] As a reminder, check your plan's policies as they may vary from plan to plan. For example, Wellcare considers Canalith a covered procedure, but there must be
[5]:
- Diagnosis of 386.11 BPPV confirmed by a positive Hallpike test; AND,
- Member had symptoms of BPPV for at least four months
What to look for?
There are many data mining techniques to detect suspect billing around Canalith. Some suggestions include:
- Excessive billing of 95992
- Billing of 95992 without an appropriate diagnosis to indicate BPPV
- Billing for Canalith under another procedure code. For example, Wellcare does not consider Canalith appropriate for Vertiginous migraine (Diagnosis 346.00 - 346.93). Look for patients with those diagnosis codes and other physical therapy related codes (97XXX series).
- Look for patients where a provider submitted a claim for 95992 and it was denied. Then look for resubmissions with different procedure codes
Healthcare Fraud Shield recommends using a data mining tool such as PostShield to identify providers billing inappropriately for Canalith. Questions or comments? Please feel free to contact Healthcare Fraud Shield's Subject Matter Experts at SIU@hcfraudshield.com
for more information.