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
Code Modifiers
Same-Day Billing Restrictions
Laterality
Professional and Technical Component
Additional Resources
CPT Codes & Special Medicare Rules for Audiologists

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 shouldn't be used frequently because the Medicare contractor could determine 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

Medicare Payment for Outpatient Audiology and Speech-Language Pathology Services
Providing Telehealth Services Under Medicare During the COVID-19 Pandemic
National Correct Coding Initiative (NCCI) for Audiology and Speech-Language Pathology Services (CCI Edits and Medically Unlikely Edits)
Medicare Part B Claims Checklist
Medicare FAQs for Audiologists (ABNs, Incident-to billing)
Medicare Resources for Audiologists
Coding Resources for Audiologists
CMS: Audiology Services

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 in 2021. See Audiology CPT and HCPCS Code Changes for 2021
92518	Vestibular evoked myogenic potential testing, with interpretation and report; ocular (oVEMP)	New in 2021. See Audiology CPT and HCPCS Code Changes for 2021
92519	Vestibular evoked myogenic potential testing, with interpretation and report; cervical (cVEMP) and ocular (oVEMP)	New in 2021. See 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 Prepare for New and Revised CPT Codes Set to Debut in 2020 To report 92548, sensory organization testing must include all six conditions, as outlined in the code descriptor.
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 Prepare for New and Revised CPT Codes Set to Debut in 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	Deleted in 2022. Report (unlisted procedure) for Bekesy testing. See: Audiology CPT and HCPCS Code Changes for 2022
92562	Loudness balance test, alternate binaural or monaural
92563	Tone decay test
92564	Short increment sensitivity index (SISI)	Deleted in 2022. Report 92700 (unlisted procedure) for SISI testing. See: Audiology CPT and HCPCS Code Changes for 2022
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 in 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 in 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 in 2020. See also: Coding and Payment for Aural Rehabilitation Services and Dos and Don'ts for Revised Implant-Related Auditory Function Evaluation CPT Codes.
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 in 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 in 2021. See: 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 in 2021. See: 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 doesn't 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 be considered billable to Medicare by audiologists, although some may be performed by audiologists "incident to" a physician, when performed within the audiology scope of practice and in compliance with state laws and regulations. This means the audiologist's services are billed under the physicians NPI and the physician must be on premises when services are provided. Some services outside of the Medicare audiology benefit may also be billed directly to the Medicare beneficiary, such as hearing aid services.

CPT Code	Descriptor	Special Medicare Rules
69209	Removal impacted cerumen using irrigation/lavage, unilateral	Covered if performed under supervision of physician and under the physician's NPI. Routine cerumen removal is included in the payment for each diagnostic test and is not separately billable. If a physician removes 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	Deleted in 2022. Report 92700 (unlisted procedure) for group testing. However, group testing isn’t paid under the MPFS. See also: Audiology CPT and HCPCS Code Changes for 2022
92560	Bekesy audiometry; screening	Deleted in 2022. Report 92700 (unlisted procedure) for Bekesy screening. However, Medicare doesn’t cover screenings. See also: Audiology CPT and HCPCS Code Changes for 2022
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. See also: Coding and Payment for Aural Rehabilitation Services
92633	Auditory rehabilitation; post-lingual hearing loss
92650	Auditory evoked potentials; screening of auditory potential with broadband stimuli, automated analysis	New in 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; 3–4 studies	Covered if performed under supervision of physician and billed under the physician's NPI.
95909	Nerve conduction studies; 5–6 studies	Covered if performed under supervision of physician and billed under the physician's NPI.
95910	Nerve conduction studies; 7–8 studies	Covered if performed under supervision of physician and billed under the physician's NPI.
95911	Nerve conduction studies; 9–10 studies	Covered if performed under supervision of physician and billed under the physician's NPI.
95912	Nerve conduction studies;11–12 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.
98966	Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure with the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion	Not covered under the audiology benefit. See also: Use of CTBS Codes During COVID-19
98967	Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure with the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
98968	Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure with the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion
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 in 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
98975	Remote therapeutic monitoring (eg, therapy adherence, therapy response); initial set-up and patient education on use of equipment	New in 2022. Not covered under the audiology benefit. See also: Audiology CPT and HCPCS Code Changes for 2022 and Use of CTBS Codes During COVID-19
98976	Remote therapeutic monitoring (eg, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days
98977	Remote therapeutic monitoring (eg, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days
98978	Remote therapeutic monitoring (eg, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor cognitive behavioral therapy, each 30 days	New in 2023. Not covered under the audiology benefit. See also: Audiology CPT and HCPCS Code Changes for 2023 and Use of CTBS Codes During COVID-19
98980	Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes	New in 2022. Not covered under the audiology benefit. See also: Audiology CPT and HCPCS Code Changes for 2022 and Use of CTBS Codes During COVID-19
98981	Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes (listed separately in addition to code for primary procedure)
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 in 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