Official CPT Description

Transcription

1 s CPT Removal impacted cerumen (separate procedure), one or both ears Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual Facial nerve function studies (eg, electroneurography) 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 This is used to report cerumen removal; Medicare will not reimburse independent audiologists for this procedure but patients may be charged privately for removal of impacted cerumen Auditory processing therapies or treatment (Note: Medicare does not reimburse for this code if provided by an independent audiologist; it can be reimbursed if provided by a speech language pathologist); many private insurance carriers may cover the procedure if provided by an independent audiologist. This code is used to bill for electroneurography (ENoG) This bundled code is used to bill for codes 92545, 92542, 92544, and when they are performed on the same patient on the same date of service is not included in this bundle and should still be billed separately with the appropriate number of units to reflect the number of irrigations performed Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording Positional nystagmus test, minimum of 4 positions, with recording Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests), with recording Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording Spontaneous nystagmus portion of the common ENG/VNG test protocol; if billed with either 92542, and/or (two or three of the codes) add 59 modifier Positional portion of the common ENG/VNG test protocol, including all positions and the Hallpike maneuver; if billed with either 92541, and/or (two or three of the codes) add 59 modifier Caloric portion of the common ENG/VNG test protocol, including warm, cool, and ice water irrigations; can submit this code for multiple units (1 6) Optokinetic portion of the common ENG/VNG test protocol; if billed with either 92541, and/or (two or three of the codes) add 59 modifier Oscillating tracking test, with recording Tracking portion of the common ENG/VNG test protocol; if billed with either 92541, and/or (two or three of the codes) add 59 modifier Sinusoidal vertical axis rotational testing Rotation chair testing; requires special equipment; commonly used to verify bilateral caloric weaknesses; supply documentation supporting medical necessity if claim denied Use of vertical electrodes (List separately in addition to code for primary procedure) (Use in conjunction with codes ) (For unlisted vestibular tests, use 92700) This is an add on code; it can be added to codes 92540, 92541, 92542, 92543, 92544, 92454, and if vertical electrodes are used and add diagnostic value to the procedure. This code is inappropriate for use as part of a VNG test battery when billing Medicare (except in Florida) Computerized dynamic posturography Requires special equipment; commonly used for malingerers or as part of a vestibular rehabilitation program; supply documentation supporting medical necessity if claim denied

2 92550 Tympanometry and reflex threshold measurements This bundled code is used to bill and when they are performed on the same patient on the same date of service Pure tone audiometry (threshold); air only This code is only used when performing air conduction threshold testing in isolation of 92553, 92555, and 92556, whether it is under headphones, insert phones, or in the sound field; use a 52 modifier (reduced service) if only one ear is tested Pure tone audiometry (threshold); air and bone This code is only used when performing air and bone conduction threshold testing in isolation of 92552, 92555, and 92556, whether it is under headphones, insert phones, or in the sound field; use a 52 modifier (reduced service) if only one ear is tested Speech audiometry threshold Speech reception/awareness threshold; this code is only used when performing this measure in isolation of 92552, 92553, and when it is under headphones, insert phones, or in the sound field; use a 52 modifier (reduced service) if only one ear is tested Speech audiometry threshold with speech recognition Speech reception/awareness threshold and speech recognition/speech understanding/word recognition testing; there is no CPT code for speech recognition alone; this code is only used when performing this measure in isolation of 92552, 92553, and when it is under headphones, insert phones, or in the sound field; use a 52 modifier (reduced service) if only one ear is tested Comprehensive audiometry threshold evaluation and speech recognition (92553 and combined) Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis Loudness balance test, alternate binaural or monaural This code includes air and bone conduction testing (92553), speech audiometry threshold and speech recognition testing (92556); this code cannot be unbundled (bill 92552, 92553, 92555, or in combination); bone conduction testing must be completed to bill 92557; use a 52 modifier (reduced service) if only one ear is tested This code is for a pass fail OAE screening; typically used for newborn hearing screening only; this code is non covered by Medicare This code is used to bill for the alternate loudness balance test (ABLB) to test for recruitment Tone decay test This code is used for any tone decay testing to rule out retrocochlear pathology; use a 52 modifier (reduced service) if only one ear is tested Short increment sensitivity index (SISI) This test is used to determine cochlear vs. retrocochlear pathology; use a 52 modifier (reduced service) if only one ear is tested Stenger test, pure tone This is a test for malingering; this code is billed if the test is done unilaterally or bilaterally Tympanometry (impedance testing) This code includes tympanometry and Eustachian tube dysfunction measures; some insurance carriers are beginning to bundle (add on) this procedure to the comprehensive audiogram code (92557); use a 52 modifier (reduced service) if only one ear is tested; could add a 22 modifier for Eustachian tube function and/or fistula testing

3 92568 Acoustic reflex testing; threshold This code is for comprehensive acoustic reflex measures (ipsilateral and contralateral for at least two frequencies); not reflex screenings at one frequency; some insurance carriers are beginning to bundle (add on) this procedure to the tympanometry code (92567); use a 52 modifier (reduced service) if only one ear is tested Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing This bundled code is used to bill 92567, 92568, and acoustic reflex decay when they are performed on the same patient on the same date of service. Acoustic reflex decay cannot be completed in isolation Filtered speech test This code is used for any filtered speech test that is administered in isolation; this is a measure of central auditory function; this is not appropriate to use when billing the QuickSIN Staggered spondaic word test (SSW) This code is used to for the SSW test that is administered in isolation; this is a measure of central auditory function Synthetic sentence identification test (SSI) This code is used to for the SSI ICM and/or SSI CCM tests that are administered in isolation; this is a measure of central auditory function Stenger test, speech This is a test for malingering; this code is billed if the test is done unilaterally or bilaterally Visual reinforcement audiometry (VRA) This test is typically used to test children under the age of two in the sound field or under insert phones; requires special equipment; this is not billed in addition to Conditioning play audiometry Play audiometry; this test is typically used to test children under the age of seven and the mentally disabled; this is not billed in addition to Select picture audiometry Use this code anytime a picture/spondee board or picture word list is used to assess either a speech awareness threshold or speech recognition score; this is typically used on children under the age of seven or the mentally disabled; this is not billed in addition to Electrocochleography This code is used to bill for electrocochleography (ECoG); use a 52 modifier (reduced service) if only one ear is tested Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; limited Distortion product evoked otoacoustic emissions; limited evaluation (to confirm presence or absence of hearing disorder; 3 6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report Otoneurologic or threshold search auditory brainstem response (ABR) testing; use a 22 modifier (unusual procedure services) and provide documentation if perform middle latency, late latency, stacked and/or Auditory Steady State Response testing; use a 52 modifier (reduced service) if only one ear is tested Screening auditory brainstem response testing that is typically provided as part of a newborn hearing screening program; use a 52 modifier (reduced service) if only one ear is tested Diagnostic otoacoustic emissions test requires testing and interpretation of 3 11 distinct frequencies per ear; interpretation (not just pass/fail) and report required; use a 52 modifier (reduced service) if only one ear is tested

4 92588 Distortion product evoked otoacoustic emissions; comprehensive (qualitative analysis of outer hair cell function by cochlear mapping; minimum of 12 frequencies), with interpretation and report Hearing aid examination and selection; monaural Hearing aid examination and selection; binaural Diagnostic otoacoustic emissions test requires testing and interpretation of 12 or more distinct frequencies per ear; interpretation (not just pass/fail) and report required; use a 52 modifier (reduced service) if only one ear is tested Hearing aid evaluation/consultation for a patient with a monaural hearing loss; many private insurance carriers and the hearing aid if the patient has hearing aid coverage; this is the same as CPCS code V5010 Hearing aid evaluation/consultation for a patient with a binaural hearing loss; Medicare does not cover this procedure; many private insurance carriers and Medicaid programs cover this procedure separately from the hearing aid if the patient has hearing aid coverage; this is the same as HCPCS code V Hearing aid check; monaural This code is used to bill for a hearing aid check on a monaural hearing aid many private insurance carriers and the hearing aid if the patient has hearing aid coverage; this is the same as HCPCS code V Hearing aid check; binaural This code is used to bill for a hearing aid check on a set of binaural hearing aids; many private insurance carriers and the hearing aid if the patient has hearing aid coverage; this is the same as HCPCS code V Electroacoustic evaluation for hearing aid; monaural This code is used to bill for an electroacoustic analysis on a monaural hearing aid; many private insurance carriers and the hearing aid if the patient has hearing aid coverage; this is the same as HCPCS code V Electroacoustic evaluation for hearing aid; binaural This code is used to bill for an electroacoustic analysis on a set of binaural hearing aids; many private insurance carriers and Medicaid programs cover this procedure separately from the hearing aid if the patient has hearing aid coverage; this is the same as HCPCS code V Ear protector attenuation measures This code is used to bill for objectively confirming the attenuation of ear protection on a given patient; this code is allowed by Medicare if medically necessary (Hyperacusis, recruitment, misophonia, tinnitus) Diagnostic analysis of cochlear implant, patient under 7 years of age; with programming Diagnostic analysis of cochlear implant, patient under 7 years of age; subsequent reprogramming Per CPT, this code is used for post operative analysis and fitting of previously placed external devices, connection to the cochlear implant, and programming of the stimulator ; this is used to cover the initial speech processor programming, including the fitting of a upgraded speech processor; add 50 or RT/LT modifiers and bill twice for binaural implants Per CPT, this code is used for subsequent sessions for measurements and adjustment of the external transmitter and re programming of the internal stimulator ; this is used to cover all follow up speech processor programming; add 50 or RT/LT modifiers and bill twice for binaural implants

5 92603 Diagnostic analysis of cochlear implant, age 7 years or older; with programming Diagnostic analysis of cochlear implant, age 7 years or older; with subsequent reprogramming Evaluation of central auditory function, with report; initial 60 minutes Evaluation of central auditory function, with report; each additional 15 minutes Assessment of tinnitus (includes pitch, loudness matching and masking) Evaluation of Auditory Rehabilitation Status; first hour Per CPT, this code is used for post operative analysis and fitting of previously placed external devices, connection to the cochlear implant, and programming of the stimulator ; this is used to cover the initial speech processor programming, including the fitting of a upgraded speech processor; add 50 or RT/LT modifiers and bill twice for binaural implants Per CPT, this code is used for subsequent sessions for measurements and adjustment of the external transmitter and re programming of the internal stimulator ; this is used to cover all follow up speech processor programming; add 50 or RT/LT modifiers and bill twice for binaural implants This code is used for the first 60 minutes of a central auditory processing assessment; this code requires the completion of a report that outlines the tests performed, the results and the amount of time it took to administer the test battery and create the report; please note that this code cannot be used in conjunction with This code is used for each additional 15 minutes (after the first 60 minutes covered in 92620) of a central auditory processing assessment and should always be billed in conjunction with 92620; this code requires the completion of a report that outlines the tests performed, the results and the amount of time it took to administer the test battery and create the report; please note that this code cannot be used in conjunction with This code is used to diagnostically assess and measure tinnitus; please ensure that all three requirements: pitch, loudness matching and masking have been assessed and documented; if you do not complete all three requirements, add a 52 modifier This code is used when assessing a patient s aural rehabilitation for diagnostic/treatment purposes; this code would be used as part of most cochlear implant and bone anchored hearing aid candidacy determination batteries and central auditory processing assessments; this could also be used to report speech in noise testing or hearing aid testing that is being paid for privately by the patient and some third party payers who allow for payment; this code is used to report face to face time with the patient or family only

6 92627 Evaluation of Auditory Rehabilitation Status; each additional 15 minutes This code is for each additional 15 minutes (after the first hour covered in 92626) of assessing a patient s aural rehabilitation for diagnostic/treatment purposes and should always be billed with 92626; this code would be used as part of most cochlear implant and bone anchored hearing aid candidacy determination batteries and central auditory processing assessments; this could also be used to report speech in noise testing or hearing aid testing that is being paid for privately by the patient and some thirdparty payers who allow for payment; this code is used to report face to face time with the patient or family only Auditory rehabilitation; pre lingual hearing loss This code is used for aural rehabilitation of those whose hearing loss occurred prior to the acquisition of speech; (Note: Medicare does not cover this code); many private insurance carriers may cover this procedure Auditory rehabilitation; post lingual hearing loss Unlisted otorhinolaryngological service or procedure Canalith repositioning procedure(s) (eg Epley maneuver, Semont maneuver), per day This code is used for aural rehabilitation of those whose hearing loss occurred after the acquisition of speech; (Note: Medicare does not cover this code); many private insurance carriers may cover this procedure This code is used to bill for procedures which do not have a CPT code (i.e. removal of incidental cerumen, use of goggles, saccade testing, VEMPs, high frequency audiometry, head shake testing, tinnitus retraining); would recommend procedures such as these be provided on a private pay basis following the completion of an Advanced Beneficiary Notice as a Required Notification; if must bill third party, create supporting documentation that includes complete description of the procedure, its diagnostic or rehabilitative value, any equipment that is needed, the time it takes to administer, and any special knowledge required to administer; create a fee that represents the cost of your time, overhead, and equipment in performing this procedure; send this documentation with any denial/appeal Do not use this code in conjunction with (Spontaneous nystagmus, including gaze, without recording) or (Positional nystagmus test, without recording; Medicare will not reimburse an audiologist for providing this service; as a result, the Medicare beneficiary would pay privately to have this procedure completed as it is statutorily excluded; many private insurance carriers will reimburse audiologist for providing this procedure

7 99366 Medical team conference with interdisciplinary team of health care professionals, face to face with patient and/or family, 30 minutes or more, participation by non physician qualified health care professional Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present; 30 minutes or more, participation by non physician qualified health care professional Patient or family present; requires a minimum of three providers; typically used for cochlear implant, bone anchored hearing aid, pediatric, or central auditory processing team conference; not used for meetings in educational settings Patient or family not present; requires a minimum of three providers; typically used for cochlear implant, bone anchored hearing aid, pediatric, or central auditory processing team conference; not used for meetings in educational settings Current Procedural Terminology (CPT) is copyright 2014 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. The above summary and description of uses was prepared by Kim Cavitt, Au.D., Audiological Resources, exclusively for the Academy of Doctors of Audiology. DISCLAIMER: The foregoing information is provided as a resource for our members. ADA makes no recommendation as to the accuracy or suitability of the information for your particular situation. Neither ADA, nor any of its officers, directors, agents, employees, committee members or other representatives shall have any liability for any claim, whether founded or unfounded, of any kind whatsoever, including, but not limited to, any claim for costs and legal fees, arising from the use of these opinions. Last Updated 3/2014