American Speech-Language-Hearing Association

Medically Unlikely Edits for Audiology Services

Medically Unlikely Edits (MUEs), a subset of the National Correct Coding Initiative (CCI), are used for Medicare Part B and Medicaid claims. An MUE for a CPT or HCPCS Level II (supplies, equipment, and, devices) code specifies the maximum number of times that the code can be reported for the same patient on the same day. There are separate MUEs for office and hospital outpatient settings, though the edits for audiology are similar in both settings. The following tables for audiology-related MUEs are derived from the complete lists of edits published on the Centers for Medicare & Medicaid Services (CMS) MUE Web site. They list codes that have MUEs and the number of times each code may be billed for the same patient on the same day for both office and outpatient settings.

An exception may be requested for medically reasonable and necessary services that exceed the MUE limit by reporting certain modifiers, as outlined by CMS.

Note: Not all codes have an MUE.

Table 1: CPT Code MUEs for Audiology Services

CPT Code MUE Values 
  Office Setting Hospital Outpatient Setting
69210[1] 1 1
92507[2] 1 1
92508[2] 1 1
92516 1 1
92541 1 1
92542 1 1
92543 4 4
92544 1 1
92545 1 1
92546 1 1
92548 1 1
92552 1 1
92553 1 1
92555 1 1
92556 1 1
92557 1 1
92561 1 1
92562 1 1
92563 1 1
92564 1 1
92565 1 1
92567 1 1
92568 1 1
92571 1 1
92572 1 1
92575 1 1
92576 1 1
92577 1 1
92579 1 1
92582 1 1
92583 1 1
92584 1 1
92585 1 1
92586 1 1
92587 1 1
92588 1 1
92596 1 1
92601 1 1
92602 1 1
92603 1 1
92604 1 1
92620 1 1
92625 1 1
92626 1 1
95922[2] 1 1
95925 1 1
95926 1 1
95927 1 1
95930 1 1
95934 1 1
95936 2 2

 

Table 2: HCPCS Code MUEs for Audiology

Note: Medicare does not cover routine physical checkups for the purposes of prescribing, fitting, or changing hearing aids or examinations for hearing aids.

HCPCS Code MUE Values 
  Office Setting Hospital Outpatient Setting
L8614 2 2
L8615 2 2
L8616 2 2
L8617 2 2
L8618 2 2
L8619 2 2
L8622 2 2
V5008 1 N/A
V5010 1 N/A
V5011 1 N/A

See also:

[1] Current CMS Policy considers removal of cerumen a component of audiologic diagnostic testing and not paid separately. Under Medicare, CPT 69210 is not recognized. See Medicare Coverage Policy on Cerumen Management.

[2] Medicare does not cover this service under the audiology benefit. 

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