Coding for Reimbursement Frequently Asked Questions: Audiology
Where can audiologists obtain a complete listing of codes, both procedure and diagnostic?
ASHA's "Health Plan Coding and Claims Guide" provides resources on coding, billing, appeals, denials, and other helpful information. This guide is available through the ASHA online store or through ASHA's Product Sales at 1-888-498-6699. Ask for Item #0112486.
A list of CPT codes with short descriptors and associated fees for speech-language pathology and audiology can be found in the ASHA Medicare Fee Schedule or the Superbill for Audiology Practice [PDF]. Go to the American Medical Association's (AMA) website to order the official CPT Manual.
What is a "superbill?"
A superbill is a time efficient form to document services, fees, codes, and other information required by health plans. Models are available for download by selecting Superbill for Audiology Practice [PDF].
What is a CMS 1500 form?
Non-institutional providers and suppliers use the CMS 1500 form to bill Medicare Part B services, Medicaid, and private health plans. To print black and white copies [PDF], contact the Centers for Medicare and Medicaid Services (CMS) through their website at or your local Medicare carrier.
What are place of service codes and where can audiologists obtain a complete listing of them, with descriptions?
Place of service codes are used on claims to specify the entity where service(s) were rendered. Check with individual payers (e.g., Medicare, Medicaid, private health plans) for policies regarding these codes.
You may find a comprehensive list of place of service codes, with descriptions, at the Centers for Medicare and Medicaid Services' (CMS) website.
How do I code for tinnitus assessment?
Beginning on January 1, 2005, audiologists can use 92625, Assessment of tinnitus (includes pitch, loudness matching, and masking). Audiologists are instructed not to report 92625 in conjunction with 92562 (loudness balance testing).
Can audiologists bill CPT 92543 for each caloric irrigation performed?
Yes. The CPT descriptor for this code states "per irrigation."
At one time, Medicare in error allowed 92543 to be billed only once even when multiple irrigations were performed.
What are the infant hearing testing codes?
There are a number of codes that can be used to describe early hearing detection testing to a payer. The procedure code you use depends on (a) whether you are conducting an initial infant hearing screening (limited test) or performing a more comprehensive test on the infant and (b) the testing method you use to evaluate infants.
If you test infants via auditory evoked potentials, the two codes available are:
92585, Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system, comprehensive
92586, Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system, limited
If you test infants via otoacoustic emissions, the codes available are:
92558, Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis
92587, Distortion product evoked otoacoustic emissions, limited evaluation (to confirm the presence or absence of hearing disorder, 3–6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report92588, Comprehensive or diagnostic evaluation (comparison of transient and distortion product otoacoustic emissions at multiple levels and frequencies)
92588, Distortion product evoked otoacoustic emissions, comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report
For more information on the appropriate use of these OAE codes, see CPT Coding for Otoacoustic Emissions: FAQs.
How do audiologists code "normal hearing" results when performing a hearing screening or an audiological evaluation?
Medicare's policy is that you should code for the sign(s) or symptom(s) that prompted the test to be ordered. For instance, a newborn fails an infant hearing screening and is referred for follow up testing which results in normal findings. In this situation, 389.9 (Unspecified hearing loss) would be appropriate.
Private health plans often do follow Medicare policies. It is important that you check with the plan in question.
What code/s should I use for auditory processing (AP) evaluation and treatment?
An audiologist performing an AP evaluation can code in one of two ways:
- If the audiologist is performing more than one test, we recommend the use of the following combination of codes:
If the audiologist is performing only a single test, we recommend the use of one of the following codes, as appropriate:
- 92620 (Evaluation of central auditory function, with report; initial 60 minutes)
- 92621 (each additional 15 minutes)
- NOTE: 92620 and 92621 cannot be reported in conjunction with 92506
- NOTE: 92620 and 92621 should be reported when a central auditory function battery is performed.
The diagnostic codes used by audiologists for diagnosing central auditory processing disorders are in the 388.4 series (other abnormal auditory perception) or 794.15 (abnormal auditory function study - if electrophysiological tests are performed).
The diagnostic code used by SLPs for diagnosing auditory processing disorders is 315.32 (developmental mixed receptive-expressive language disorder, central auditory processing disorder).
- 92571 (filtered speech test);
- 92572 (staggered spondaic word test); and
- 92576 (synthetic sentence identification test).
Can procedure codes be billed by units of time?
Most audiology procedure codes do not have time units assigned to them. Therefore, if no time is noted, each code counts as one session. These codes are listed in ASHA's "Health Plan Coding and Claims Guide" (available through the ASHA online store, Item #0112486). A complete list of the CPT codes for speech-language pathology and audiology services can also be found in the Medicare Fee Schedule or the Superbill for Audiology Practice [PDF]. For more information, see Timed & Untimed CPT Codes.
Can the services provided by a Clinical Fellow (CF) be submitted to a health plan for reimbursement?
There is no uniform standard for private payers, so we look to Medicare's guidance.
Federal Medicaid regulations define CFs as qualified audiologists and do not mention licensure. However, a state Medicaid program can supercede Federal regulations when the state requirement is more stringent. Thus, Medicaid programs could require licensed practitioners and disallow non-licensed CFs.
How do I establish fees for audiology services?
You may refer to the Medicare Fee Schedule for a general idea of what Medicare reimburses for specific procedures. It is important for you to know that Medicare rates reflect a budgetary constraint and may not reflect current market rates. You can also purchase historic fee data from medical coding publishers. ASHA's "Negotiating Health Care Contracts and Calculating Fees" (available through the ASHA online store, Item #0112450) also offers national charge data to help you evaluate your fees by comparing your charges to those of other practitioners nationwide.
Discussing fees with other local practices may be construed as price-fixing. Setting prices in collusion with colleagues is illegal.
What are the new CPT procedures and codes for aural rehabilitation in 2006?
- 92626 Evaluation of auditory rehabilitation status; 1st hour
- +92627 each additional 15 minutes (List separately in addition to code for primary procedure)
- 92630 Auditory rehabilitation; pre-lingual hearing loss
- 92633 Auditory rehabilitation; post-lingual hearing loss
What has happened to the descriptors of 92506 and 92507 in 2006? Don't they include aural rehabilitation?
The descriptors have been revised for 2006 to eliminate the reference to aural rehabilitation. The descriptors now read:
- 92506 Evaluation of speech, language, voice, communication, and/or auditory processing
- 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder
I heard that the acoustic reflex testing descriptor changed in 2006. Is that true?
Yes. CPT 92568 now reads: Acoustic reflex testing; threshold. The new descriptor makes it clear that the code for acoustic reflex threshold testing only and that testing for decay is a separate procedure.
What is the appropriate CPT code for Auditory Steady-State-Response System Testing (ASSR)?
Code ASSR under 92585. The descriptor for 92585 appears to make it a general category for comprehensive auditory evoked potentials except for electrocochleography (92584).
What CPT code should I use for Vestibular Evoked Myogenic Potential (VEMP) testing?
There is no specific CPT code for VEMP testing. Audiologists should use 92700, Unlisted otorhinolaryngological service or procedure.