The content in the following billing and coding for audiology services FAQs was compiled in collaboration with the Academy of Doctors of Audiology (ADA), the American Academy of Audiology (AAA), and the American Speech-Language-Hearing Association (ASHA).
The International Classification of Diseases (ICD) codes are numeric or alpha-numeric codes that are used to classify a diagnosis. The ICD-CM (Clinical Modification) is the version of ICD that is used in the United States.
The U.S. transitioned from ICD-9-CM (9th Revision) in October 2015 and is currently using the ICD-10-CM (10th Revision). The following ICD-10-CM resources have been developed specifically for audiologists:
Coding for diagnostic tests should be consistent with the following guidelines:
See also: Coding Normal Results
Current Procedural Terminology (CPT®) codes (developed and maintained by the American Medical Association) are five-digit codes that designate a distinct test or therapeutic procedure. Each code has a description of the procedure or group of procedures that are included with the code. The procedure(s) included in the description are used to assess the value of that code.
Documentation in the patient''s medical record should support the reason that testing was completed and the reason why particular codes are being billed. Payers may deny payment if documentation is missing or is not consistent with the codes billed.
This add on code has historically been utilized for the use of electrodes when performing electronystagmography (ENG). CPT code 92547 should be utilized for ENG only.
It is suggested you consult with commercial payers as to their guidance with videonystagmography (VNG) and the vertical channel as electrodes are not utilized with VNG. For use of vertical electrodes please consult the payers guidance as to the number of units allowed. The numbers of units may range from one unit per date of service to one unit for each test for which the electrodes were utilized.
As indicated in the Current Procedural Terminology (CPT) manual, the Audiologic Function Tests (Codes 92550 through 92700) include the testing of both ears. If only one ear instead of two ears is tested, the -52 modifier (Reduced Services) should be utilized.
The one exception to this relates to the use of 92601-92604, which involves the post-operative analysis, fitting, and adjustments of a cochlear implant. Given that this code is described in the singular application, this code in isolation would be insufficient to address the analysis, fitting and adjustments of a bilateral cochlear implantation. In these circumstances, where bilateral cochlear implants are fit and managed, we recommend that a -22 modifier (Unusual procedural service) be added to the applicable code of 92601-92604 and that the necessary documentation be submitted with the claim. This documentation should outline what differentiates a singular cochlear implant fitting/remapping from a bilateral cochlear implant fitting/remapping and it should address any additional time, equipment, staffing, etc. required. Some payers may require the RT modifier to indicate the right ear and the LT modifier to indicate the left ear when there are bilateral cochlear implants.
Otoacoustic emissions are not warranted in every test scenario. The documentation must substantiate the need for service.
CPT code 92587, distortion product OAEs (DPOAEs) or transient evoked OAEs (TEOAEs), limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies), with interpretation and report, is to be utilized when testing TEOAEs and/or DPOAES. The procedure involves testing 3-11 discrete frequencies (i.e., 3-11 frequencies per ear) in both the right and left ears. The interpretation cannot be merely a “pass/fail” but, instead, must clearly document the ear and frequency-specific test results. The reduced service modifier is indicated if only testing one ear.
CPT code 92588, Comprehensive diagnostic evaluation (cochlear mapping, minimum of 12 frequencies), with report, is a more extensive OAE test that involves at least 12 frequencies in the right ear and 12 in the left and the interpretation of the test and the report in the patient’s record. Higher frequency resolution testing is recommended in applications requiring greater sensitivity to subtle changes in cochlear function. This includes, but is not limited to, ototoxicity evaluation (baseline and monitoring), hearing conservation, tinnitus evaluation, hereditary hearing loss evaluation, monitoring recovery from sudden hearing loss, and site of lesion evaluation. See also: CPT Coding for Otoacoustic Emissions FAQs
Yes. To appropriately bill for acoustic reflex testing, the audiologist must perform both contralateral and ipsilateral reflexes. If you are only performing ipsilateral reflexes, you must append the -52 modifier to indicate reduced services. A reduced services modifier is not required for incomplete stimulus frequencies, as long as there is a combination of the four test conditions that are necessary to obtain the complete diagnostic information. However, if one or more of the test conditions is not performed (e.g., two contralateral stimulations and one ipsilateral stimulation or two contralateral stimulations only), then use of modifier 52, Reduced services, would be appropriate to signify that the basic protocol for the procedure has not been altered, but the entire procedure has not been performed. (CPT Assistant, June 2009).
An ipsilateral acoustic reflex screening at 1000 Hz does not meet the coding criteria for 92568, because the protocol for this procedure requires obtaining the threshold level for the acoustic reflex and not simply observing the presence or absence of an acoustic reflex at a single intensity level.
Speech-in-noise testing could be included in a comprehensive audiologic evaluation (92557) or as part of speech audiometry with speech recognition evaluation (92556). Alternatively, it could be billed as an unlisted otorhinolaryngological procedure (92700), with documentation and explanation of the procedure. Audiologists should consult payer guidelines for submitting the unlisted code. See also: The ASHA Leader "New Procedures...But No Codes"
CPT code 92700 should not be filed to Medicare if utilized as a predictor of hearing aid performance in noise.
Speech-in-noise testing should not be billed as a Filtered Speech Test (92571), as this code is one component of a comprehensive central auditory processing evaluation, and because filtered speech is not a speech-in-noise test.
Effective January 1, 2021, audiologists should use the following VEMP-specific CPT codes.
92517, Vestibular evoked myogenic potential testing, with interpretation and report; cervical (cVEMP)
92518, Vestibular evoked myogenic potential testing, with interpretation and report; ocular (oVEMP)
92519, Vestibular evoked myogenic potential testing, with interpretation and report; cervical (cVEMP) and ocular (oVEMP)
For more information, see Audiology CPT and HCPCS Code Changes for 2021.
The HCPCS (healthcare common procedure coding system) descriptions and HCPCS codes describing contralateral routing hearing devices and systems changed in 2019. They are:
V5171 Hearing aid, contralateral routing device, monaural, in the ear (ite)
V5172 Hearing aid, contralateral routing device, monaural, in the canal (itc)
V5181 Hearing aid, contralateral routing device, monaural, behind the ear (bte)
V5190 Hearing aid, contralateral routing, monaural, glasses
V5200 Dispensing fee, contralateral, monaural
V5211 Hearing aid, contralateral routing system, binaural, ite/ite
V5212 Hearing aid, contralateral routing system, binaural, ite/itc
V5213 Hearing aid, contralateral routing system, binaural, ite/bte
V5214 Hearing aid, contralateral routing system, binaural, itc/itc
V5215 Hearing aid, contralateral routing system, binaural, itc/bte
V5221 Hearing aid, contralateral routing system, binaural, bte/bte
V5230 Hearing aid, contralateral routing system, binaural, glasses
V5240 Dispensing fee, contralateral routing system, binaural
Use the codes labeled contralateral routing device to report current contralateral routing technology. Use the monaural codes to report one contralateral routing device (i.e., when the patient already has a hearing aid) and the binaural codes to report one hearing aid and one contralateral routing device (i.e., a contralateral routing system).
Unless you are specifically instructed to do so by the payer, it may be considered a fraudulent billing practice to submit a claim for both a contralateral device or system and a hearing aid. Please read and review your Medicaid and third-party payer contracts to determine the coverage specifics related to contralateral routing hearing devices and systems for each payer. State Medicaid programs may have specific coding and coverage guidance unique to provision of these devices in a particular state. As indicated in previous joint communications [PDF], it may be useful to itemize/unbundle the hearing aid claims to maximize third-party reimbursement of these devices.