Medicare Coverage Policy on Cerumen Removal

The Centers for Medicare and Medicaid Services (CMS) does not separately reimburse audiologists for cerumen removal. According to the Federal Register:

...routine removal of cerumen is not paid separately. It is considered to be part of the procedure with which it is billed (for example, audiologic function testing)...This code should not be used when the audiologist removes cerumen, because removal of cerumen is considered to be part of the diagnostic testing and is not paid separately.

Source: Federal Register, December 31, 2002, pp. 80011–12

CMS reimburses physicians under the following two codes:

  1. G0268 Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing
    • CMS explains that the code was created in order to allow payment to a physician who removes impacted cerumen on the same date as a contracted or employed audiologist who performs audiologic function testing.
      Source: Coding Clinic; 2003, Q1, P12
  2. 69210 Removal of impacted cerumen (separate procedure), 1 or both ears
    • According to the CPT Assistant (July 2005), "Removing wax that is not impacted does not warrant the reporting of CPT code 69210." This code should only be used by a physician on a day when no audiologic function tests occur.

The American Academy of Otolaryngology-Head and Neck Surgery collaborated with the American Medical Association CPT Assistant (July 2005) and provided four considerations, each of which defines impacted cerumen:

  • Visual: cerumen impairs exam of significant portions of the external auditory canal, tympanic membrane, or middle ear condition
  • Qualitative: extremely hard, dry, irritative cerumen
  • Inflammatory: associated with foul odor, infection, or dermatitis
  • Quantitative: obstructive, copious cerumen that cannot be removed without magnification and multiple instrumentations

They also said that billing for impacted cerumen removal is appropriate if removal requires the use of at least an otoscope and instrumentation such as wax curettes.

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