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]
|
|
| 92506 |
92620 or 92621 |
Y
|
Y
|
-59
|
| 92540 |
92541, 92542, 92544, 92545 |
N
|
N
|
N/A
|
| 92541 |
92542, 92544, or 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, or 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 |
92506-92508, 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
|
92506, 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
|
92506, 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
|
92506, 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.