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.
CMS reimburses physicians under the following codes:
- 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
- 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.
- 69209 Removal impacted cerumen using irrigation/lavage, unilateral
- This code should only be used by a physician on a day when no audiologic function tests occur.
- This code should only be used by a physician on a day when no audiologic function tests occur.
- 69210 Removal of impacted cerumen requiring instrumentation, unilateral
- This code should only be used by a physician on a day when no audiologic function tests occur.
The codes listed above should only be billed for the removal of impacted cerumen The American Medical Association CPT Assistant (October 2013) provides 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 causing symptoms such as pain, itching, hearing loss, etc.
- Inflammatory: associated with foul odor, infection, or dermatitis.
- Quantitative: obstructive, copious cerumen that cannot be removed without magnification and multiple instrumentations requiring physician skills.
For further information regarding audiology billing for cerumen removal, please contact reimbursement@asha.org.
