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CPT® Codes CPT Code 69209 Official CPT Description Removal of impacted cerumen using irrigation/lavage, unilateral Uses This is used to report removal of impacted (cannot see clinically significant portions of the tympanic membrane) cerumen using irrigation and/or lavage. Medicare will not reimburse independent audiologists for this procedure but patients may be charged privately for removal of impacted cerumen. This is a unilateral code. If the procedure is performed bilaterally you must add the ‐50 (bilateral procedure) modifier to the claim. 69210 Removal impacted cerumen using instrumentation, unilateral This is used to report removal of impacted (cannot see clinically significant portions of the tympanic membrane) cerumen using instrumentation other than irrigation/lavage such as curettes and/or alligator clips; Medicare will not reimburse independent audiologists for this procedure but patients may be charged privately for removal of impacted cerumen. This is a unilateral code. If the procedure is performed bilaterally you must add the ‐50 (bilateral procedure) modifier to the claim. 92516 Facial nerve function studies (eg, electroneurography) This code is used to bill for electroneurography (ENoG) 92531 Spontaneous nystagmus test, including gaze, without recording. This code is used to perform any spontaneous or gaze testing, without recording (just visualization). Medicare does not cover this procedure. 92532 Positional nystagmus test, without recording This code is used when you perform any form of positional testing, such as a Hallpike Maneuver, without recording (just visualization). Medicare does not cover this procedure. 92537 Caloric vestibular test with recording, bilateral, bi‐thermal (i.e.one warm and one cool irrigation in each ear for a total of four irrigations) This code is for bilateral, bi‐thermal (four irrigations total) caloric testing. This code should not be billed as multiple units. If three irrigations are completed, a ‐52 (reduced services) modifier should be added. If more than four irrigations are completed, a ‐22 (increased procedural service) modifier should be added to the claim. 92538 Caloric vestibular test with recording, bilateral, mono‐thermal (i.e.one irrigation in each ear for a total of two irrigations) This code is for bilateral, mono‐thermal (two irrigations total) caloric testing. This code should not be billed as multiple units. If one irrigation is completed, a ‐52 (reduced services) modifier should be added to the claim. 92540 Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording This bundled code is used to bill for codes 92545, 92542, 92544, and 92545 when they are performed on the same patient on the same date of service. 92537/8 are not included in this bundle and should be billed separately. 92541 Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording Spontaneous nystagmus portion of the common ENG/VNG test protocol; if billed with either 92542, 92544 and/or 92545 (two or three of the 92540 codes) add the ‐59 (distinct procedural service) modifier to the claim. 92542 Positional nystagmus test, minimum of 4 positions, with recording Positional portion of the common ENG/VNG test protocol, including all positions and the Hallpike maneuver; if billed with either 92541, 92544 and/or 92545 (two or three of the 92540 codes) add the ‐59 (distinct procedural service) modifier to the claim. 92544 Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording Optokinetic portion of the common ENG/VNG test protocol; if billed with either 92541, 92542 and/or 92545 (two or three of the 92540 codes) add ‐59 modifier to the claim. 92545 Oscillating tracking test, with recording Tracking portion of the common ENG/VNG test protocol; if billed with either 92541, 92542 and/or 92544 (two or three of the 92540 codes) add ‐59 modifier to the claim. 92546 Sinusoidal vertical axis rotational testing Rotation chair testing; requires special equipment; commonly used to verify bilateral caloric weaknesses; supply documentation supporting medical necessity if claim denied. 92547 Use of vertical electrodes (List separately in addition to code for primary procedure) (Use 92547 in conjunction with codes 92541‐ 92546) (For unlisted vestibular tests, use 92700) This is an add‐on code; it can be added to codes 92537, 92538, 92540, 92541, 92542, 92544, 92545, and/or 92546 if vertical electrodes are used and add diagnostic value to the procedure. This code is inappropriate for use as part of a VNG test battery when billing Medicare (except in Florida) 92548 Computerized dynamic posturography Requires special equipment; commonly used for malingerers or as part of a vestibular rehabilitation program; supply documentation supporting medical necessity if claim denied
CPT Code Official CPT Description Uses 92550 Tympanometry and reflex threshold measurements This bundled code is used to bill 92567 and 92568 when they are performed on the same patient on the same date of service. 92551 Screening test, pure‐tone, air only. This is the code for a pass‐fail pure‐tone screening. This is inappropriate to use when thresholds are established. Medicare does not cover this procedure. This code means the same thing as V5008 (hearing screening). 92552 Pure tone audiometry (threshold); air only This code is only used when performing air conduction threshold testing in isolation of 92553, 92555, and 92556, whether it is under headphones, insert phones, or in the sound field; use a ‐52 modifier (reduced service) if only one ear is tested. Add a ‐59 (distinct procedural service) if performed with 92555 or 92556. 92553 Pure tone audiometry (threshold); air and bone This code is only used when performing air and bone conduction threshold testing in isolation of 92552, 92555, and 92556, whether it is under headphones, insert phones, or in the sound field; use a ‐52 modifier (reduced service) if only one ear is tested or if only bone is performed. Add a ‐
59 (distinct procedural service) if performed with 92555. 92555 Speech audiometry threshold Speech reception/awareness threshold; this code is only used when performing this measure in isolation of 92552, 92553, and 92556 when it is under headphones, insert phones, or in the sound field; use a ‐52 modifier (reduced service) if only one ear is tested. Add a ‐59 (distinct procedural service) if performed with 92552 or 92553. 92556 Speech audiometry threshold with speech recognition Speech reception/awareness threshold and speech recognition/speech understanding/word recognition testing; there is no CPT code for speech recognition alone; this code is only used when performing this measure in isolation of 92552, 92553, and 92555 when it is under headphones, insert phones, or in the sound field; use a ‐52 modifier (reduced service) if only one ear is tested or if only speech recognition testing is performed. Add a ‐59 (distinct procedural service) if performed with 92552. 92557 Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined) This code includes air and bone conduction testing (92553), speech audiometry threshold and speech recognition testing (92556); this code cannot be unbundled (bill 92552, 92553, 92555, or 92556 in combination); bone conduction testing must be completed to bill 92557; use a ‐52 modifier (reduced service) if only one ear is tested or if not all components of the code are performed. 92558 Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis This code is for a pass‐fail OAE screening with automated interpreatation; typically used for newborn hearing screening only; this code is non‐covered by Medicare 92563 Tone decay test This code is used for any tone decay testing to rule out retrocochlear pathology; use a ‐52 modifier (reduced service) if only one ear is tested 92565 Stenger test, pure tone This is a test for malingering; this code is billed if the test is done unilaterally or bilaterally 92567 Tympanometry (impedance testing) This code includes tympanometry and Eustachian tube dysfunction measures; some insurance carriers are beginning to bundle (add on) this procedure to the comprehensive audiogram code (92557); use a ‐52 modifier (reduced service) if only one ear is tested; could add a ‐22 modifier for Eustachian tube function and/or fistula testing CPT Code Official CPT Description Uses 92568 Acoustic reflex testing; threshold This code is for comprehensive acoustic reflex measures (ipsilateral and contralateral for at least two frequencies); not reflex screenings at one frequency; some insurance carriers are beginning to bundle (add on) this procedure to the tympanometry code (92567); use a ‐52 modifier (reduced service) if only one ear is tested 92570 Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing This bundled code is used to bill 92567, 92568, and acoustic reflex decay when they are performed on the same patient on the same date of service. Acoustic reflex decay cannot be completed in isolation 92571 Filtered speech test This code is used for any filtered speech test of central auditory fucntion that is administered in isolation; this is a measure of central auditory function; this is not appropriate to use when billing the QuickSIN. 92572 Staggered spondaic word test (SSW) This code is used to for the SSW test that is administered in isolation; this is a measure of central auditory function 92576 Synthetic sentence identification test (SSI) This code is used to for the SSI‐ICM and/or SSI‐CCM tests that are administered in isolation; this is a measure of central auditory function 92577 Stenger test, speech This is a test for malingering; this code is billed if the test is done unilaterally or bilaterally 92579 Visual reinforcement audiometry (VRA) This test is typically used to test children under the age of two in the sound field and/or under insert phones for speech and/or tones; requires special equipment; this is not billed in addition to 92557 92582 Conditioning play audiometry Play audiometry; this test is typically used to test children under the age of seven and the mentally disabled; this is not billed in addition to 92557 92583 Select picture audiometry Use this code anytime a picture/spondee board or picture word list is used to assess either a speech awareness threshold or speech recognition score; this is typically used on children under the age of seven or the mentally disabled; this is not billed in addition to 92557 92584 Electrocochleography This code is used to bill for electrocochleography (ECoG) and cochlear implant neurotelemetry, either intraoperatively or postoperatively; use a ‐52 modifier (reduced service) if only one ear is tested. 92585 Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive Otoneurologic or threshold search auditory brainstem response (ABR) testing; use a ‐22 modifier (unusual procedure services) and provide documentation if perform middle‐latency, late latency, stacked and/or Auditory Steady State Response testing; use a ‐52 modifier (reduced service) if only one ear is tested 92586 Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; limited Screening auditory brainstem response testing that is typically provided as part of a newborn hearing screening program; use a ‐52 modifier (reduced service) if only one ear is tested 92587 Distortion product evoked otoacoustic emissions; limited evaluation (to confirm presence or absence of hearing disorder; 3‐6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report Diagnostic otoacoustic emissions test requires testing and interpretation of 3‐11 distinct frequencies per ear; interpretation (not just pass/fail) and report required; use a ‐52 modifier (reduced service) if only one ear is tested CPT Code Official CPT Description Uses 92588 Distortion product evoked otoacoustic emissions; comprehensive (qualitative analysis of outer hair cell function by cochlear mapping; minimum of 12 frequencies), with interpretation and report Diagnostic otoacoustic emissions test requires testing and interpretation of 12 or more distinct frequencies per ear; interpretation (not just pass/fail) and report required; use a ‐52 modifier (reduced service) if only one ear is tested 92590 Hearing aid examination and selection; monaural Hearing aid evaluation/consultation for a patient with a monaural hearing loss; many private insurance carriers and Medicaid programs cover this procedure separately from the hearing aid if the patient has hearing aid coverage; this is the same as CPCS code V5010 92591 Hearing aid examination and selection; binaural Hearing aid evaluation/consultation for a patient with a binaural hearing loss; Medicare does not cover this procedure; many private insurance carriers and Medicaid programs cover this procedure separately from the hearing aid if the patient has hearing aid coverage; this is the same as HCPCS code V5010 92592 Hearing aid check; monaural This code is used to bill for a hearing aid check on a monaural hearing aid many private insurance carriers and Medicaid programs cover this procedure separately from the hearing aid if the patient has hearing aid coverage; this is the same as HCPCS code V5011 92593 Hearing aid check; binaural This code is used to bill for a hearing aid check on a set of binaural hearing aids; many private insurance carriers and Medicaid programs cover this procedure separately from the hearing aid if the patient has hearing aid coverage; this is the same as HCPCS code V5011 92594 Electroacoustic evaluation for hearing aid; monaural This code is used to bill for an electroacoustic analysis on a monaural hearing aid; many private insurance carriers and Medicaid programs cover this procedure separately from the hearing aid if the patient has hearing aid coverage; this is the same as HCPCS code V5011 92595 Electroacoustic evaluation for hearing aid; binaural This code is used to bill for an electroacoustic analysis on a set of binaural hearing aids; many private insurance carriers and Medicaid programs cover this procedure separately from the hearing aid if the patient has hearing aid coverage; this is the same as HCPCS code V5011 92596 Ear protector attenuation measures This code is used to bill for objectively confirming the attenuation of ear protection on a given patient; this code is allowed by Medicare if medically necessary (Hyperacusis, recruitment, misophonia, tinnitus) 92601 Diagnostic analysis of cochlear implant, patient under 7 years of age; with programming Per CPT, this code is used for “post‐operative analysis and fitting of previously placed external devices, connection to the cochlear implant, and programming of the stimulator”; this is used to cover the initial speech processor programming, including the fitting of a upgraded speech processor; add ‐50 or RT/LT modifiers and bill twice for binaural implants; add a ‐59 (distinct procedural service) if performed on the sale date of service as 92526. 92602 Diagnostic analysis of cochlear implant, patient under 7 years of age; subsequent reprogramming Per CPT, this code is used for “subsequent sessions for measurements and adjustment of the external transmitter and re‐programming of the internal stimulator”; this is used to cover all follow‐up speech processor programming; add ‐ 50 or RT/LT modifiers and bill twice for binaural implants; add a ‐59 (distinct procedural service) if performed on the sale date of service as 92526. CPT Code Official CPT Description Uses 92603 Diagnostic analysis of cochlear implant, age 7 years or older; with programming Per CPT, this code is used for “post‐operative analysis and fitting of previously placed external devices, connection to the cochlear implant, and programming of the stimulator”; this is used to cover the initial speech processor programming, including the fitting of a upgraded speech processor; add ‐50 or RT/LT modifiers and bill twice for binaural implants; add a ‐59 (distinct procedural service) if performed on the sale date of service as 92526. 92604 Diagnostic analysis of cochlear implant, age 7 years or older; with subsequent reprogramming Per CPT, this code is used for “subsequent sessions for measurements and adjustment of the external transmitter and re‐programming of the internal stimulator”; this is used to cover all follow‐up speech processor programming; add ‐ 50 or RT/LT modifiers and bill twice for binaural implants; add a ‐59 (distinct procedural service) if performed on the sale date of service as 92526. 92620 Evaluation of central auditory function, with report; initial 60 minutes This code is used for the first 60 minutes of a central auditory processing assessment; this code requires the completion of a report that outlines the tests performed, the results and the amount of time it took to administer the test battery and create the report. 92621 Evaluation of central auditory function, with report; each additional 15 minutes This code is used for each additional 15 minutes (after the first 60 minutes covered in 92620) of a central auditory processing assessment and should always be billed in conjunction with 92620; this code requires the completion of a report that outlines the tests performed, the results and the amount of time it took to administer the test battery and create the report. 92625 Assessment of tinnitus (includes pitch, loudness matching and masking) This code is used to diagnostically assess and measure tinnitus; please ensure that all three requirements: pitch, loudness matching and masking have been assessed and documented; if you do not complete all three requirements, add a ‐52 (reduced services) modifier 92626 Evaluation of Auditory Rehabilitation Status; first hour This code is used when assessing a patient’s aural rehabilitation for diagnostic/treatment purposes; this code would be used as part of most cochlear implant and bone anchored hearing aid candidacy determination batteries and central auditory processing assessments; this could also be used to report speech‐in‐noise testing or hearing aid testing that is being paid for privately by the patient and some third‐party payers who allow for payment; this code is used to report face to face time with the patient or family only CPT Code Official CPT Description Uses 92627 Evaluation of Auditory Rehabilitation Status; each additional 15 minutes This code is for each additional 15 minutes (after the first hour covered in 92626) of assessing a patient’s aural rehabilitation for diagnostic/treatment purposes and should always be billed with 92626; this code would be used as part of most cochlear implant and bone anchored hearing aid candidacy determination batteries and central auditory processing assessments; this could also be used to report speech‐in‐noise testing or hearing aid testing that is being paid for privately by the patient and some third‐ party payers who allow for payment; this code is used to report face to face time with the patient or family only 92630 Auditory rehabilitation; pre‐lingual hearing loss This code is used for aural rehabilitation of those whose hearing loss occurred prior to the acquisition of speech; (Note: Medicare does not cover this code); many private insurance carriers may cover this procedure 92633 Auditory rehabilitation; post‐lingual hearing loss This code is used for aural rehabilitation of those whose hearing loss occurred after the acquisition of speech; (Note: Medicare does not cover this code); many private insurance carriers may cover this procedure 92700 Unlisted otorhinolaryngological service or procedure 95992 Canalith repositioning procedure(s) (eg Epley maneuver, Semont maneuver), per day This code is used to bill for procedures which do not have a CPT code (i.e. removal of incidental cerumen, use of goggles, saccade testing, VEMPs, high frequency audiometry, euctachian tube function testing, VHiT, head shake testing, tinnitus retraining); would recommend procedures such as these be provided on a private pay basis following the completion of an Advanced Beneficiary Notice as a Required Notification; if must bill third party, create supporting documentation that includes complete description of the procedure, its diagnostic or rehabilitative value, any equipment that is needed, the time it takes to administer, and any special knowledge required to administer; create a fee that represents the cost of your time, overhead, and equipment in performing this procedure; send this documentation with any d i l/
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Do not use this code in conjunction with 92531 (Spontaneous nystagmus, including gaze, without recording) or 92532 (Positional nystagmus test, without recording; Medicare will not reimburse an audiologist for providing this service; as a result, the Medicare beneficiary would pay privately to have this procedure completed as it is statutorily excluded; many private insurance carriers will reimburse audiologist for providing this procedure CPT Code Official CPT Description Uses 99366 Medical team conference with interdisciplinary team of health care professionals, face to face with patient and/or family, 30 minutes or more, participation by non‐physician qualified health care professional Patient or family present; requires a minimum of three providers; typically used for cochlear implant, bone anchored hearing aid, pediatric, or central auditory processing team conference; not used for meetings in educational settings 99368 Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present; 30 minutes or more, participation by non‐physician qualified health care professional Patient or family not present; requires a minimum of three providers; typically used for cochlear implant, bone anchored hearing aid, pediatric, or central auditory processing team conference; not used for meetings in educational settings Current Procedural Terminology (CPT) is copyright 2016 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. The above summary and description of “uses” was prepared by Kim Cavitt, Au.D., Audiological Resources, exclusively for the Academy of Doctors of Audiology. DISCLAIMER: The foregoing information is provided as a resource for our members. ADA makes no recommendation as to the accuracy or suitability of the information for your particular situation. Neither ADA, nor any of its officers, directors, agents, employees, committee members or other representatives shall have any liability for any claim, whether founded or unfounded, of any kind whatsoever, including, but not limited to, any claim for costs and legal fees, arising from the use of these opinions. Last Updated 7/2016