Medicare CPT Coding Rules for Audiology Services

This page contains important Medicare policies related to Current Procedural Terminology (CPT® American Medical Association) coding for audiology services, including a complete list of CPT codes and special coding rules. While these coding guidelines are based on Medicare policies, they are often adopted by other third party payers. CPT Assistant references are American Medical Association policies. Audiologists should also verify payment rules with their local Medicare Administrative Contractor.

On this page:

See also: Medicare Coding Rules for Speech-Language Pathology Services

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. A timed code is billed only if 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

Code Modifiers

Untimed CPT codes represent "typical" visit lengths or times to conduct a typical test unless the time is specified in the CPT descriptor. 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. For claims with the "-22" modifier a description of the need for extended services should accompany the claim. Modifier "-59" is used to establish one procedure as distinct from another procedure billed on the same day. However, audiologists should not use modifier "-59" unless directed by Medicare through same-day billing guidelines.

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.

CPT Codes & Special Medicare Rules for Audiologists

CPT Code Descriptor Special Medicare 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. (Reference: CPT Assistant, June 2004, p. 10)                                                                             

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)

69210 Removal of impacted cerumen requiring instrumentation, 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)    

92506 Evaluation of speech, language, voice, communication, and/or auditory processing disorder

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

92549

with motor control test (MCT) and adaptation test (ADT)

New, effective January 1, 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.

92551

Screening test, pure tone, air only Screens are not covered.

92552

Pure tone audiometry (threshold); air only  

92553

Air and bone  

92555

Speech audiometry threshold  

92556

Speech audiometry with speech recognition  

92557

Comprehensive audiometry threshold evaluation and speech recognition

CCI edits disallow 92552, 92533, 92555, or 92556 on same day.

92558 Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis Screens are not covered.

92559

Audiometric testing of groups Not covered by Medicare. 

92560

Bekesy audiometry; screening

Screens are not covered.

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  
92585 Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive
92586 Limited  
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  
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
92596 Ear protector attenuation measurements  
92601 Diagnostic analysis of cochlear implant, patient under 7 years of age; with programming
92602 Subsequent reprogramming  
92603 Diagnostic analysis of cochlear implant, age 7 years or older, with programming  
92604 Subsequent reprogramming  

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.  
92621 Each additional 15 minutes

This is the add-on code for 92620

See Medically Unlikely Edits for restrictions on multiple billings.

See 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

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.

See The Right Time for Billing Codes for information on how to report timed codes. 

92630 Auditory rehabilitation; pre-lingual hearing loss

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

92633 Auditory rehabilitation; post-lingual hearing loss

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

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) May not be used for Medicare purposes. Use G0453 instead.
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.

 

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