American Speech-Language-Hearing Association

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Medicare CPT Coding Rules for Audiology Services

This page contains important Medicare policies related to CPT [1] coding for services rendered by audiologists, including a complete list of CPT codes and special coding rules. While these rules are set by the Centers for Medicare & Medicaid Services (CMS), they are often adopted by other third party payers. CPT Assistant references are American Medical Association policies.

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See also: Medicare Coding Rules for Speech-Language Pathology Services

Designation of Time

The CPT procedures for audiology do not include time designations except for the five codes listed below. If the CPT descriptor has no time designation, the procedure is billed as a session without regard to time.

CMS cautions audiologists on calculating time attributed to the five timed audiology evaluation codes and stresses that activities such as counseling, establishment of interventional goals, or evaluating potential for remediation are not included as diagnostic tests, and that time spent on these activities should not be included in billing for

  • 92620 (evaluation of central auditory function, with report; initial 60 minutes)
  • 92621 (evaluation of central auditory function, with report; each additional 15 minutes)
  • 92626 (evaluation of auditory rehabilitation status; first hour)
  • 92627 (evaluation of auditory rehabilitation status; each additional 15 minutes)
  • 92640 (diagnostic analysis with programming of auditory brainstem implant, per hour).

Note: A timed code is billed only if testing is at least 51% of the time designated in the code's descriptor.

15 Minute Codes

For CPT codes designated as 15 minutes, multiple coding represents minimum face-to-face treatment, as follows

1 unit: 8 minutes to < 23 minutes

2 units: 23 minutes to < 38 minutes

3 units: 38 minutes to < 53 minutes

4 units: 53 minutes to < 68 minutes

5 units: 68 minutes to < 83 minutes

6 units: 83 minutes to < 98 minutes

Code Modifiers

Untimed CPT codes represent "typical" visit lengths or times to conduct a typical test unless the time is specified in the CPT descriptor. For significantly atypical procedures, a "-22"modifier can be used to indicate that the work is substantially greater than typically required and a "-52"modifier for an abbreviated procedure. Modifier "-22" should not be used frequently because the Medicare contractor could make the determination that the procedure reflects typical service delivery. For claims with the "-22" modifier a description of the need for extended services should accompany the claim. Modifier "-59" is used to establish one procedure as distinct from another procedure billed on the same day.

Same-Day Billing Restrictions

For restrictions on certain CPT code pairs billed on the same day, see Medicare's National Correct Coding Initiative (CCI) edits.

CPT Codes & Special Medicare Rules for Audiologists

CPT Code

Descriptor

Special Medicare Rules

testing one ear only

Audiometric test codes assume that both ears are tested.

When only one ear is tested, attach modifier -52 to indicate less than the usual procedure[2]

69210

Removal of impacted cerumen (separate procedure, one or both ears)

Not covered. Cerumen removal is included in the relative value for each diagnostic test. If physician is needed to remove impacted cerumen on the same day as a diagnostic test, the physician bills a special Medicare code: G0268.[3]

92506

Evaluation of speech, language, voice, communication, and/or auditory processing disorder

Not covered. Medicare coverage is limited to diagnostic testing. Use new 92626 for evaluation of aural rehabilitation status.

92507

Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual

Not covered. Medicare coverage is limited to diagnostic testing.

92510

Aural rehabilitation following cochlear implant. Code deleted in 2006.

See related codes 92601-92604; 92626 - 92633

92516

 Facial nerve function studies (eg, electroneuronography)

Covered if performed under supervision of physician
92540

Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional hystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording. (Do not report in conjunction with 92541, 92542, 92544, or 92545)

 

Do not report 92540 in conjunction with 92541, 92542, 92544, or 92545.[4]

Audiologists billing 92541, 92542, 92544, and 92545 on the same day should now use 92540. If not performing all four codes on the same day, one may bill the individual CPT codes.
92541

Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording. (Do not report 92541 in conjunction with 92540 or the set of 92542, 92544, and 92545)

Parenthetical portion added by the AMA as an editorial correction in July 2010.

See 92540

92542

 Positional nystagmus test, minimum of 4 positions, with recording. (Do not report 92542 in conjunction with 92540 or the set of 92541, 92544, and 92545)

Parenthetical portion added by the AMA as an editorial correction in July 2010.

See 92540

92543

 Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests), with recording.

Billed for each irrigation. (Except for hospital outpatient PPS, where payment is adjusted for billing one time only.) [5]

 

92544

 Optokinetic nystagmus test, bi-directional, foveal or peripheral stimulation, with recording. (Do not report 92544 in conjunction with 92540 or the set of 92541, 92542, and 92545)

Parenthetical portion added by the AMA as an editorial correction in July 2010.

See 92540

92545

 Oscillating tracking test, with recording. (Do not report 92545 in conjunction with 92540 or the set of 92541, 92542, and 92544)

Parenthetical portion added by the AMA as an editorial correction in July 2010.

See 92540

92546

 Sinusoidal vertical axis rotational testing.

 

92547

 Use of vertical electrodes (List separately in addition to code for primary procedure) Report this code in addition to the code(s) for the primary procedures for each vestibular test performed (92541-92546). [6]

92548

 Computerized dynamic posturography

 
92550 Tympanometry and reflex threshold measurements

Do not report 92550 in conjunction with 92567, 92568 [7]

Audiologists billing 92567 and 92568 on the same day should now use 92550. If not performing both codes on the same day, one may bill the individual CPT code.

92551

 Screening test, pure tone, air only Not covered because it is a screen. Note: This is the only audiometric test within the scope of practice of a speech-language pathologist.

92552

 Pure tone audiometry (threshold); air only

 

92553

 Air and bone CCI edits disallow 92552 or 92556 on same day.

92555

 Speech audiometry threshold

 

92556

 Speech audiometry with speech recognition CCI edits disallow 92555 on same day.

92557

 Comprehensive audiometry threshold evaluation and speech recognition

CCI edits disallow 92552, 92533, 92555, or 92556 on same day.
92558 Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis Screens are not covered.

92559

 Audiometric testing of groups

Not covered.

92560

 Bekesy audiometry; screening

Screens are not covered.

92561

Bekesy; diagnostic

 

92562

 Loudness balance test, alternate binaural or monaural

 

92563

 Tone decay test CCI edits disallow 92552 or 92553 on same day.

92564

 Short increment sensitivity index (SISI)

 

92565

 Stenger test, pure tone

 

92567

 Tympanometry (impedance testing)

See 92550

92568

 Acoustic reflex testing; threshold

See 92550

92569

 Acoustic reflex decay test

Deleted in 2010. Audiologists should now use CPT 92570, since acoustic reflex decay testing is always done in conjunction with tympanometry and acoustic reflex threshold testing.
92570 Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing

Do not report 92570 in conjunction with 92567, 92568 [8]

Audiologists billing 92567, 92568, and acoustic reflex decay test (formerly 92569) on the same day should now use 92550. If not performing all codes on the same day, one may bill the individual CPT code.

92571

 Filtered speech test

 

92572

 Staggered spondaic word test

 

92573

 Lombard test

Deleted in 2006. Use 92700 to report Lombard Test.
92575 Sensorineural acuity level test

 
92576 Synthetic sentence identification test

 
92577 Stenger test; speech

 
92579 Visual reinforcement audiometry (VRA)

 
92582 Conditioning play audiometry

 
92583 Select picture audiometry

 
92584 Electrocochleography  
92585 Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive

CCI edits allow 92586 on same day with -59 modifier.
92586 Limited

 
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 report  
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 CCI edits allow 92587 on same day with -59 modifier.
92596 Ear protector attenuation measurements

 
92601 Diagnostic analysis of cochlear implant, patient under 7 years of age; with programming

CCI edits allow 92602, 92567, 92568, 92585, and/or 92586 on same day with -59 modifier.
92602 Subsequent reprogramming CCI edits allow 92602, 92567, 92568, 92585, and/or 92586 on same day with -59 modifier.

92603 Diagnostic analysis of cochlear implant, age 7 years or older, with programming CCI edits allow 92604, 92567, 92568, 92585, and/or 92586 on same day with -59 modifier.

92604 Subsequent reprogramming CCI edits allow 92567, 92568, 92585, and/or 92586 on same day with -59 modifier.

92620

 Evaluation of central auditory processing, with report; initial 60 minutes Part of a battery of site-of-lesion tests; therefore ASHA recommends that 92620/92621 not be billed in combination with 92571, 92572, or 92576. [9]
92621 Each additional 15 minutes

92625 Tinnitus assessment (includes pitch, loudness, matching, and masking)

CCI edits allow 92562 on same day with -59 modifier.
92626 Evaluation of auditory rehabilitation status, first hour

Covered for audiologists as well as speech-language pathologists.[10] This code may be used for aural rehabilitation status evaluation potentially leading to a cochlear implant.
92627

Each additional 15 minutes

 
92630

Auditory rehabilitation; pre-lingual hearing loss

Not covered for audiologists

SLPs must use 92507 in lieu of this code [11]
92633 Auditory rehabilitation; post-lingual hearing loss

Not covered for audiologists

SLPs must use 92507 in lieu of this code [12]
95907 Nerve conduction studies; 1-2 studies New code effective January 1, 2013. Covered if performed under supervision of physician. See New & Revised CPT Codes.
95908 Nerve conduction studies; 3–4 studies New code effective January 1, 2013. Covered if performed under supervision of physician. See New & Revised CPT Codes.
95909 Nerve conduction studies; 5–6 studies New code effective January 1, 2013. Covered if performed under supervision of physician. See New & Revised CPT Codes.
95910 Nerve conduction studies; 7–8 studies New code effective January 1, 2013. Covered if performed under supervision of physician. See New & Revised CPT Codes.
95911 Nerve conduction studies; 9–10 studies New code effective January 1, 2013. Covered if performed under supervision of physician. See New & Revised CPT Codes.
95912 Nerve conduction studies;11–12 studies New code effective January 1, 2013. Covered if performed under supervision of physician. See New & Revised CPT Codes.
95913 Nerve conduction studies; 13 or more studies New code effective January 1, 2013. Covered if performed under supervision of physician. See New & Revised CPT Codes.
95920 Intraoperative neurophysiology testing, per hour (List separately in addition to code for primary procedure)

Deleted, effective January 1, 2013. See 95940, 95941, and G0453.
95925 Somatosensory testing; in upper limbs

Covered if performed under supervision of physician.
95926 Somatosensory testing; in lower limbs

Covered if performed under supervision of physician.
95927 Somatosensory testing; in trunk or head

Covered if performed under supervision of physician.
95930 Visual evoked potential (VEP) testing central nervous system, checkerboard or flash

Covered if performed under supervision of physician.
95934 H-reflex, amplitude and latency study; record gastrocnemius/soleus muscle

Deleted effective January 1, 2013. See 95907-95913.
95936 Record muscle other than gastrocnemius/soleus muscle
Deleted effective January 1, 2013. See 95907-95913.
95937 Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any one method

Covered if performed under supervision of physician.
95940 Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure) New code effective January 1, 2013. Covered if performed under supervision of physician. See New & Revised CPT Codes.
95941 Continuous neurophysiology monitoring, from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately in addition to code for primary procedure) New code effective January 1, 2013. May not be used for Medicare purposes. Use G0453 instead. See New & Revised CPT Codes.
G0453 Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure) New code effective January 1, 2013. This is a Medicare-only code. Use instead of 95941. See New & Revised CPT Codes.

[1] All CPT codes and descriptors are copyright American Medical Association

[2] CPT Assistant, June 2004, p. 10

[3] Federal Register, December 31, 2002, pp. 80011-12; CPT Assistant, July 2005

[4] 2010 CPT Manual

[5] Federal Register, October 31, 1997, p. 59076.

[6] CPT Assistant, February, 2005, p. 13.

[7] 2010 CPT Manual

[8] ibid

[9] Medicare consultant and audiology members of ASHA's Health Care Economics Committee.

[10] 2006 Medicare Physician Fee Schedule

[11] ibid

[12] ibid

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