What code or codes do I use when I perform auditory brainstem response (ABR) testing?
The limited auditory evoked potential code (92586) is generally used by Universal Newborn Hearing Screening (UNHS) programs for screening and is occasionally used by neurology for single high level ABR stimuli.
The comprehensive auditory evoked potential code (92585) should be used for all other auditory evoked response testing, including testing via air and bone conduction.
At this time there is not a CPT code that differentiates "threshold-search" ABR from "diagnostic" ABR.
If I perform threshold-search ABR and auditory steady-state response (ASSR) testing on the same day, what procedures should I bill?
ASSR is considered to be a type of auditory evoked potential test and currently does not have a specific CPT code. The comprehensive auditory evoked potential code (92585) is the most appropriate code for billing ASSR at this time.
92585 is a session-based code; this means that it can only be billed one time per day, even if both ABR and ASSR testing are completed on that day.
As discussed above, an extended service modifier (-22) could be considered when both ABR and ASSR are completed on the same day. Detailed documentation of the justification for the extended service should be included in the patient’s medical record.
When would it be appropriate to use the -33 CPT code modifier for OAE or ABR tests that are part of newborn hearing screening?
The -33 modifier was designed to allow providers a means to identify preventative services such as newborn hearing screening or re-screening procedures. In some cases these services are mandated by the Patient Protection and Affordable Care Act (ACA) and should not be subject to a patient cost share (i.e., co-pay, deductible, etc.).
As the use of modifiers varies widely between payers, it is recommended that you consult your payers to determine the recommended utilization for the -33 modifier for newborn hearing screening or re-screening procedures.
For more information regarding the -33 modifier, please review resources available from the American Medical Association [PDF].
I see two codes for an auditory processing evaluation (92620 and 92621) and two codes for an evaluation of aural rehabilitation status (92626 and 92627). How do I use these codes?
These codes require that the primary evaluation codes (92620 or 92626), which include the first 60 minutes of evaluation time, be billed before the additional 15-minute codes (92621 or 92627).
For example, first bill 92620 (Evaluation of central auditory function, with report; initial 60 minutes), then 92621 for each additional 15 minutes of evaluation time.
When using time-based codes, the audiologist is required to properly document evaluation start and end times in the patient’s medical record.
Note: The use of 92626 and 92627 as described below is specifically for pediatric applications. Please see other professional guidance for the correct use of this code when evaluating Medicare-eligible recipients.
92626 and 92627 are codes that reflect the evaluation of a child’s ability to use residual hearing with a hearing aid or cochlear implant.
The evaluation process focuses on a battery of procedures designed to examine—in much greater detail than a standard audiogram—the magnitude of speech understanding abilities with and without amplification or cochlear implant devices, the suitability and usability of various assistive listening devices, and the appropriateness of alternative alerting devices.
92626 and 92627 are timed codes on the basis that there will be a battery of standardized tests used to make the assessment. The number of tests included in the evaluation will vary according to the age and capability of the child. Whereas a young child may be limited in the number of tests that can be completed, an older child will be able to complete a greater number and variety of tests.
Another purpose of the evaluation is to determine whether the child could be a cochlear implant candidate and to document progress in speech understanding post-implant. Evaluation results can be used as a diagnostic foundation that leads to a customized intervention program for that child.
92626 and 92627 cannot be used as counseling codes.
If I perform an evaluation for (central) auditory processing (92620) and include filtered fpeech (92571), staggered spondaic words (92572), and synthetic sentence identification (92576), can I bill the specific test codes in addition to the general auditory processing evaluation code?
Check with your payer. There is a National Correct Coding Initiative (NCCI) edit that prohibits billing 92571, 92572, and 92576 on the same day as 92620 for Medicare beneficiaries. Many Medicaid and private payers utilize NCCI edits in their coding guidelines.
If I spend two hours programming a cochlear implant (CI) processor for a new user, can I bill more than one unit of 92601 or 92603?
The CI codes (92601-92604) are session-based codes and only one unit (code) should be billed per day.
CI codes 92601 (diagnostic analysis of cochlear implant, younger than 7 years of age; with programming) and 92603 (diagnostic analysis of cochlear implant, age 7 years or older; with programming) describe the post-operative analysis and fitting, connection to the implant, and initial programming of the stimulator.
Codes 92602 (younger than 7 years of age, subsequent re-programming) and 92604 (7 years or older, subsequent re-programming) are used for subsequent sessions to include measurement, adjustments, and re-programming.
Reimbursement for binaural CI programming varies between payers. Please consult your payer(s) to determine if CI programming codes (92601-92604) are considered unilateral or single device codes.
Some payers may accept two line items of the same code with –RT or –LT ear modifiers to designate which side was programmed.
Other payers may consider a binaural programming session as a same-day repeat procedure. In this case, a separate bill with the same date of service would be completed. The second CI programming code would be billed with a repeat procedure modifier added (-76: Repeat procedure by same provider; or -77: Repeat procedure by another provider).
