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Medicare CPT Coding Rules for Audiology Services

This page provides an overview of Current Procedural Terminology (CPT® American Medical Association) coding policies for Medicare Part B (outpatient) audiology services, including a complete list of CPT codes and special coding rules. Although these coding guidelines are based on Medicare policies, keep in mind that other third party payers may adopt similar policies. CPT Assistant references are American Medical Association policies for coding best practice. Audiologists should also verify payment rules with their local Medicare Administrative Contractor and review ASHA's annual analysis of the Medicare Physician Fee Schedule for Medicare Part B policy changes and national payment rates.

Please contact reimbursement@asha.org for questions related to audiology services.

On this page:

Designation of Time

Most CPT/HCPCS codes reported by audiologists are untimed and do not include time designations in the code descriptor. An untimed code is billed once per day, regardless of the time spent providing the service. On the other hand, timed codes include a time designation in the descriptor (for example, "per hour," "first hour," "initial 15 minutes," "each additional 30 minutes") and may be billed multiple times per day to represent the amount of time spent in direct patient care. Bill a timed code only when face-to-face time spent in an evaluation is at least 51% of the time designated in the code's descriptor. 

See also: The Right Time for Billing Codes

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 22 minutes

2 units: 23 minutes to 37 minutes

3 units: 38 minutes to 52 minutes

4 units: 53 minutes to 67 minutes

5 units: 68 minutes to 82 minutes

6 units: 83 minutes to 97  minutes, and so on and so forth.

Code Modifiers

Clinicians use code modifiers appended to CPT or HCPCS codes on a claim to provide additional information about the services provided. For example, untimed codes may include modifiers to represent atypical procedures. Untimed CPT codes represent the "typical" time it takes to complete a specific evaluation or treatment. 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. Claims with the -22 modifier require an additional description of the need for extended services. Modifiers -22 and -52 may not be used in conjunction with timed codes. 

Modifier -59 is used to establish one procedure as distinct from another procedure billed on the same day, but should only be used based on instruction from the payer. Medicare publishes National Correct Coding Initiative (CC) edits that may require modifier -59.

Same-Day Billing Restrictions

See Medicare's National Correct Coding Initiative (CCI) edits for restrictions on certain CPT code pairs reported on the same day.

Laterality

Unless specifically noted in the descriptor, audiology-related CPT codes represent bilateral testing. Include modifier -52 (reduced service) for unilateral testing. (Reference, CPT Assistant, June 2004, p. 10)

Codes with the Professional and Technical Component (PC/TC) Split

Some audiology codes include a PC/TC split, meaning that payment for the code can be split based on who provided specific components of the service. The professional component (PC) reflects the portion of the procedure that involves the clincian's professional work (e.g., interpreting test results). The technical component (TC) reflects the portion of the procedure that doesn't include the clinician's participation (for example, a technician's participation). The global service is billed when both the PC and TC of a service are personally furnished by the same clinician. See ASHA's Medicare Fee Schedule for Audiology Services for a listing of codes with the PC/TC split and Medicare Billing of Audiology Services for additional details.

Additional Resources

CPT Codes and Special Medicare Rules for Audiologists

Table 1: Services and Procedures Covered Under the Audiology Benefit

The following table lists services and procedures covered under the audiology diagnostic benefit. 

CPT Code Descriptor Special Medicare Rules

92517

Vestibular evoked myogenic potential testing, with interpretation and report; cervical (cVEMP)

New, effective January 1, 2021. See also: Audiology CPT and HCPCS Code Changes for 2021

92518

Vestibular evoked myogenic potential testing, with interpretation and report; ocular (oVEMP)

New, effective January 1, 2021. See also: Audiology CPT and HCPCS Code Changes for 2021

92519

Vestibular evoked myogenic potential testing, with interpretation and report; cervical (cVEMP) and ocular (oVEMP)

New, effective January 1, 2021. See also: Audiology CPT and HCPCS Code Changes for 2021

Report 92519 when performing cVEMP and oVEMP testing on the same day. Bill 92517 or 92518 if you don’t perform both tests on the same day.

Don’t report 92519 in conjunction with 92517 or 92518.

92537

Caloric vestibular test with recording, bilateral; bithermal (i.e., one warm and one cool irrigation in each ear for a total of four irrigations)

(Do not report 92537 in conjunction with 92270, 92538)

(For three irrigations, use modifier -52)

(For monothermal caloric vestibular testing, use 92538)

CPT code 92537 may not be billed more than once on the same date of service. To report more irrigations than indicated in the code, consider using the modifier -22 to indicate an increased service. In those circumstances, audiologists should be prepared to provide justification for the increased service.

92538

Caloric vestibular test with recording, bilateral; monothermal (i.e., one irrigation in each ear for a total of two irrigations)

(Do not report 92538 in conjunction with 92270, 92537)

(For one irrigation, use modifier -52)

(For bithermal caloric vestibular testing, use 92537)

CPT code 92538 may not be billed more than once on the same date of service. To report more irrigations than indicated in the code, consider using the modifier -22 to indicate an increased service. In those circumstances, audiologists should be prepared to provide justification for the increased service.

92540

Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus 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.

Audiologists billing 92541, 92542, 92544, and 92545 on the same day should use 92540. Bill the individual CPT codes if you do not report all four services on the same day.

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)

 

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)

 

92543

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

Deleted in 2016. See 92537-92538 for caloric vestibular testing.

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)

 

92545

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

 

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). (Reference: CPT Assistant, February, 2005, p. 13.)

92548

Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report; 

Revised in 2020. See New & Revised CPT Codes for 2020

92549

Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report; with motor control test (MCT) and adaptation test (ADT)

New in 2020. See New & Revised CPT Codes for 2020

This is a stand-alone code to report when performing all three CDP tests (SOT, MCT, and ADT). Do not bill in conjunction with 92548.

92550

Tympanometry and reflex threshold measurements

Do not report 92550 in conjunction with 92567, 92568  

Audiologists billing 92567 and 92568 on the same day should use 92550. Bill the individual CPT code if you do not performing both tests on the same day.

92552

Pure tone audiometry (threshold); air only

 

92553

Pure tone audiometry (threshold); air and bone

 

92555

Speech audiometry threshold;

 

92556

Speech audiometry threshold; with speech recognition

 

92557

Comprehensive audiometry threshold evaluation and speech recognition

CCI edits do not allow billing of 92552, 92553, 92555, or 92556 on the same day as 92557 because they are components of comprehensive audiometry.

Do not report 92557 if you do not complete all required components (pure tone air and bone conduction, speech reception thresholds, and speech recognition testing).  Instead, bill for the individual components of testing using 92552, 92553, 92555, and/or 92556.

92561

Bekesy; diagnostic

 

92562

Loudness balance test, alternate binaural or monaural

 

92563

Tone decay test

 

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 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

Audiologists billing 92567, 92568, and acoustic reflex decay test (formerly 92569) on the same day should now use 92550. Bill the individual CPT code if you do not perform all of the tests on the same day.

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

Use 92584 to report neural response telemetry (NRT) when performed intraoperatively or postoperatively. (Reference: CPT Assistant, July, 2011, p. 17.)

CCI edits don't allow same-day reporting of 92584 and CPT codes 96201-92604 (cochlear implant diagnostic analysis and programming) because NRT is considered bundled into the procedure when performed together. Don't use auditory evoked potential testing codes 92651-92653 for NRT. 

92585

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

Deleted, effective January 1, 2021. See new codes 92652 and 92653.

92586

Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; limited

Deleted, effective January 1, 2021. See new codes 92650 and 92651.

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

See: CPT Coding for Otoacoustic Emissions

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

See: CPT Coding for Otoacoustic Emissions

92596

Ear protector attenuation measurements

 

92601

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

92602

Diagnostic analysis of cochlear implant, patient under 7 years of age; subsequent reprogramming

 

92603

Diagnostic analysis of cochlear implant, age 7 years or older; with programming  

92604

Diagnostic analysis of cochlear implant, age 7 years or older; subsequent reprogramming

 

92620

Evaluation of central auditory processing, with report; initial 60 minutes

Don't report 92620/92621 in combination with 92571, 92572, or 92576, as they may be considered a part of the battery of tests bundled into 92620.

See also: Billing and Coding for Pediatric Audiology Services

92621

Evaluation of central auditory processing, with report; each additional 15 minutes

This is the add-on code for 92620

See Medically Unlikely Edits for restrictions on multiple billings and The Right Time for Billing Codes for information on how to report timed codes. 

92625

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

92626

Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); first hour 

Revised, effective January 1, 2020. See New & Revised CPT Codes for 2020.

92627

Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); each additional 15 minutes (list separately in addition to code for primary procedure)

(Use 92627 in conjunction with 92626)

(When reporting 92626, 92627, use the face-to-face time with the patient or family)

(Do not report 92626, 92627 in conjunction with 92590, 92591, 92592, 92593, 92594, 92595 for hearing aid evaluation, fitting, follow-up, or selection)

This is the add-on code for 92626.

See Medically Unlikely Edits for restrictions on multiple billings and The Right Time for Billing Codes for information on how to report timed codes. 

92640

Diagnostic analysis with programming of auditory brainstem implant, per hour

92651

Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report

New, effective January 1, 2021. See also: Audiology CPT and HCPCS Code Changes for 2021

92651 describes nonautomated follow-up electrophysiologic testing to rule out significant hearing loss, including auditory neuropathy/auditory dyssynchrony, or to verify the need for additional threshold testing. Testing includes obtaining responses to broadband-evoked auditory brainstem responses (ABRs) using click stimuli at moderate-to-high and low stimulus levels.

Don't report 92651 in conjunction with 92652 or 92653.

92652

Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report

New, effective January 1, 2021. See also: Audiology CPT and HCPCS Code Changes for 2021

92652 describes extensive electrophysiologic estimation of behavioral hearing thresholds using broadband and/or frequency-specific stimuli at multiple levels and frequencies. 92652 can also include testing with high level stimuli and rarefaction/condensation runs to confirm auditory neuropathy/auditory dyssynchrony.

92652 reflects comprehensive AEP testing for the purpose of quantifying type and degree of hearing loss. Don't report 92652 in conjunction with 92651 or 92653.

92653

Auditory evoked potentials; neurodiagnostic, with interpretation and report

New, effective January 1, 2021. See also: Audiology CPT and HCPCS Code Changes for 2021

92653 describes testing to evaluate neural integrity only, without defining threshold. Report this code when the purpose of testing is to identify brainstem or auditory nerve function.

92653 is a less extensive test than 92652 and the basic elements of 92653 are already included in 92651 or 92652 when they are performed to identify and quantify hearing impairment. Don't report 92653 in conjunction with 92651 or 92652.

92700

Unlisted otorhinolaryngological service or procedure

Report 92700 for a covered Medicare service that does not have a corresponding CPT code. See also: New Procedures...But No Codes

Table 2: Other CPT Codes of Interest to Audiologists

Medicare does not recognize screenings, treatment, hearing aid, and electrophysiological services outside the hearing and balance systems when performed by an audiologist. The codes listed in this table may not considered to be audiology codes billable to Medicare, although some may be performed by audiologists "incident to" a physician. This means the audiologist's services are billed under the physicians NPI and the physician must be on premises when services are provided.

CPT Code

Descriptor

Special Medicare Rules

69209

Removal impacted cerumen using irrigation/lavage, unilateral

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. (Reference:  Federal Register, December 31, 2002, pp. 80011-12; CPT Assistant, July 2005)

See also: Medicare Policy on Cerumen Removal

69210

Removal impacted cerumen requiring instrumentation, unilateral (for bilateral procedure, report 69210)

92506

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

Deleted in 2014.

92507

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

Not covered for audiologists. Medicare coverage is limited to diagnostic testing.

92516

Facial nerve function studies (eg, electroneuronography)

Covered if performed under supervision of physician and under the physician's NPI.

92551

Screening test, pure tone, air only

Not covered. Medicare doesn't reimburse for screenings.

92558

Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis

Not covered. Medicare doesn't reimburse for screenings. See also: CPT Coding for Otoacoustic Emissions

92559

Audiometric testing of groups

Not covered by Medicare. 

92560

Bekesy audiometry; screening

Not covered. Medicare doesn't reimburse for screenings.

92590

Hearing aid examination and selection; monaural

Not covered. Medicare doesn’t cover hearing aids or services directly related to hearing aids.

92591

Hearing aid examination and selection; binaural

92592

Hearing aid check; monaural

92593

Hearing aid check; binaural

92594

Electroacoustic evaluation for hearing aid; monaural

92595

Electroacoustic evaluation for hearing aid; binaural

92630

Auditory rehabilitation; pre-lingual hearing loss

Not covered under the audiology benefit. Medicare coverage is limited to diagnostic testing.

92633

Auditory rehabilitation; post-lingual hearing loss

Not covered under the audiology benefit. Medicare coverage is limited to diagnostic testing.

92650

Auditory evoked potentials; screening of auditory potential with broadband stimuli, automated analysis

New, effective January 1, 2021. See also: Audiology CPT and HCPCS Code Changes for 2021

Not covered. Medicare doesn't reimburse for screenings.

95907

Nerve conduction studies; 1-2 studies

Covered if performed under supervision of physician and billed under the physician's NPI.

95908

Nerve conduction studies; 34 studies

Covered if performed under supervision of physician and billed under the physician's NPI.

95909

Nerve conduction studies; 56 studies

Covered if performed under supervision of physician and billed under the physician's NPI. 

95910

Nerve conduction studies; 78 studies

Covered if performed under supervision of physician and billed under the physician's NPI.

95911

Nerve conduction studies; 910 studies

Covered if performed under supervision of physician and billed under the physician's NPI.

95912

Nerve conduction studies;1112 studies

Covered if performed under supervision of physician and billed under the physician's NPI.

95913

Nerve conduction studies; 13 or more studies

Covered if performed under supervision of physician and billed under the physician's NPI.

95925

Somatosensory testing; in upper limbs

Covered if performed under supervision of physician and billed under the physician's NPI.

95926

Somatosensory testing; in lower limbs

Covered if performed under supervision of physician and billed under the physician's NPI.

95927

Somatosensory testing; in trunk or head

Covered if performed under supervision of physician and billed under the physician's NPI.

95930

Visual evoked potential (VEP) testing central nervous system, checkerboard or flash

Covered if performed under supervision of physician and billed under the physician's NPI.

95937

Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any one method

Covered if performed under supervision of physician and billed under the physician's NPI.

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)

Covered if performed under supervision of physician and billed under the physician's NPI.

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)

Not billable for Medicare purposes. Use G0453 instead.

98970

Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes

Updated, effective January 1, 2021. See also: Audiology CPT and HCPCS Code Changes for 2021 and Use of CTBS Codes During COVID-19

Not covered under the audiology benefit. 

98971

Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes

98972

Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes

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)

This is a Medicare-only code for use instead of 95941. Covered if performed under supervision of physician and billed under the physician's NPI.

G2250

Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment

New, effective January 1, 2021. See also: Audiology CPT and HCPCS Code Changes for 2021 and Use of CTBS Codes During COVID-19

Not covered under the audiology benefit. 

G2251

Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

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