American Speech-Language-Hearing Association

National Correct Coding Initiative (CCI) and Outpatient Code Editor (OCE) Edit Tables

Audiology Procedures

The following tables for audiology-related CCI and OCE edits are derived from the complete lists of edits published on the Centers for Medicare & Medicaid Services (CMS) CCI website. They apply to both Medicare Part B and Medicaid services.

The tables list:

  • Code pairs that cannot be billed together for the same patient on the same date of service
  • Code pairs that can be billed together for the same patient on the same date of service by attaching a -59 modifier to bypass the code edit. The modifier indicates that the two procedures are separate and distinct (must be supported in the medical record)
    • Modifier -59 should be attached to the CPT code listed in Column 2, when applicable

Note: Audiology-related code pairs that are not listed here are not subject to CCI restrictions and can be billed on the same day without a modifier. However, audiologists should also be aware of Medically Unlikely Edit (MUE) restrictions.

Table 1: CCI and OCE Edits[1] for Audiology Services

Note: CPT 69210, cerumen removal, cannot be paid when billed on the same day as any audiometric or vestibular test. Removal of cerumen is included in the fee for diagnostic tests. See Medicare Coverage Policy on Cerumen Management for additional information.

Column 1
CPT Procedure (one)
Column 2
Paired With (one)
Can be performed on same date?
Yes/No
If so, use what modifier?[2]
Office settings Hospital outpatient settings[1]
92521, 92522, 92523, 92524 69210 (cerumen removal), 92620 (CAPD evaluation), 92621 (CAPD evaluation add-on) N N N/A
92540 92541, 92542, 92544, 92545 N N N/A
92541 92542, 92544, 92545 Y Y -59
92542 92544, 92545 Y Y -59
92544 92545 Y Y -59
92550 92567, 92568 N N N/A
92553 92552 or 92556 N N N/A
92556 92555 N N N/A
92557 92552, 92553, 92555, or 92556 N N N/A
92563 92552 or 92553 N N N/A
92568 92567 N N N/A
92570 92550, 92567, 92568 N N N/A
92585 92586 (ABR limited) N N N/A
92588 92587 (EOE limited) Y Y -59
92620 92571, 92572, 92576 N N N/A
92620 92626 Y Y -59
92621 92571, 92572, 92576 N N N/A
92625 92562 Y Y -59
92626 92621 Y Y -59
92640 92507, 92508, 92550, 92552, 92553, 92555-92558, 92561-92568, 92570-92572, 92575-92577, 92579, 92582-92588, 92596, 97755 Y Y -59

Table 2: CCI and OCE Edits[1] for Cochlear Implant Programming

Column 1
CPT Procedure (one)
Column 2
Paired With (one)
Can be performed on same date?
Yes/No
If so, use what modifier? [2]
Office setting Hospital outpatient setting[1]
92601 92507, 92508, 92550, 92567, 92568, 92570, 92585, 92586, 92602, 92626 Y Y -59
92601 92552-92565, 92569-92584, 92587-92588, 92596-92597, 92603, 92604, 97755 N N N/A
92602 92507, 92508, 92567, 92568, 92585, 92586, 92626 Y Y -59
92602 92552-92565, 92569-92584, 92587-92597, 92604, 97755 N N N/A
92603 92567, 92568, 92585, 92586, 92604, 92626 Y Y -59
92603 92552-92565, 92569-92584, 92587-92597, 92602, 97755 N N N/A
92604 92507, 92508, 92626, 92567, 92568, 92585, 92586 Y Y -59
92604 92552-92565, 92569-92584, 92587-92597, 97755 N N N/A

See also:

[1] Hospital outpatient coding edits are determined by the Outpatient Code Editor (OCE) system whic usually includes the same therapy edits. New OCE edits are implemented in hospitals one quarter after initiated as CCI edits.

[2] The -59 modifier denotes that the procedure is distinct or independent from other services performed on the same day. The modifier is attached to the column 2 CPT code, when applicable.

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