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Medicare CPT Coding Rules for Audiology Services

The table on this page provide a complete list of CPT [1] codes related to services rendered by audiologists, including special coding rules. While these rules are set by Medicare, they are often adopted by third party payers as well. CPT Assistant references are American Medical Association policies.

CPT Code	Descriptor	Special 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 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.	See 92540
92542	Positional nystagmus test, minimum of 4 positions, with recording.	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.	See 92540
92545	Oscillating tracking test, with recording.	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.
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	Covered if performed under supervision of physician
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	Evoked otoacoustic emissions, limited (single stimulus level, either transient or distortion products)
92588	Comprehensive or diagnostic evaluation (comparison of transient or distortion product otoacoustic emissions at multiple levels and frequencies)	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]
95920	Intraoperative neurophysiology testing, per hour (List separately in addition to code for primary procedure)
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	Covered if performed under supervision of physician.
95936	Record muscle other than gastrocnemius/soleus muscle	Covered if performed under supervision of physician.
95937	Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any one method	Covered if performed under supervision of physician.

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

Untimed Codes

If the CPT descriptor has no time designation, the procedure is billed as a session without regard to time.

Code Modifiers

-52 or -22 can be appended to the CPT code to indicate that the session was unusually short or long, respectively. The payer has the option to adjust the payment accordingly. If either of these modifiers are used too often, the payer may consider the incidence to not be "unusual."

Code Pairs

For restrictions on certain CPT code pairs billed on the same day, see the CCI edits.

[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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American Speech-Language-Hearing Association

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In This Section:

Medicare CPT Coding Rules for Audiology Services

15 Minute Codes

Untimed Codes

Code Modifiers

Code Pairs