Audiology CPT codes

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.

Why are there timed codes for aural rehabilitation status evaluation (92626 and 92627)?

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.

What should I code when programming or re-programming binaural cochlear implants?

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).

CPT code

What CPT codes should I use for behavioral pediatric audiologic evaluations using visual reinforcement audiometry (VRA) and conditioning play audiometry (CPA) test techniques?

92579 (VRA) and 92582 (CPA) are codes that describe specific, independent pediatric test procedures. These codes are currently valued as stand-alone procedure codes and are not "add-on" or modifier codes. Generally, these codes should not be used in addition to pure tone audiometry, air only (92552) or air and bone donduction audiometry (92553) to indicate a method of testing.

Is speech audiometry included in the CPA and VRA codes?

92579 (VRA) and 92582 (CPA) are differentiated by the method of response reinforcement used and the types of stimuli that are considered part of the procedure. These codes are historical codes and currently do not have detailed code descriptions. Payers have relied on traditional practice standards that were available at the time the codes were last valued. Historically, descriptions of VRA test procedures included both speech and tonal stimuli as part of the test protocol. In contrast, CPA test protocols included tonal stimuli but did not include speech stimuli.

If CPA (92582) testing is completed and speech measures are performed as part of the evaluation, then a code that best describes the speech measure, such as speech threshold audiometry (92555), select picture audiometry (92583), or speech audiometry threshold with speech recognition (92556), can also be reported.

What if I test individual ears using visual reinforcement audiometry techniques?

In this case, it would still be appropriate to report the VRA code (92579) as it best reflects the technique and equipment that has been utilized to conduct the assessment. Since the VRA and CPA (92582) codes cannot be billed in addition to pure-tone air or bone conduction threshold codes, you should choose the code that best aligns with your clinical assessment.

What if I attempt audiologic testing on a child but obtain limited results or no interpretable results?

The issue of limited or no audiologic test results is a complicated one; the codes that you select should accurately reflect the procedures, techniques, and effort that were used, not specifically the number of responses that were obtained.

A child may require frequent reconditioning or test reinstruction, yet limited audiologic information is obtained. In this case the audiologist has used considerable effort, various procedures, and/or different reinforcement techniques to obtain those limited results. This would not be considered a reduced service.

Documentation of the test session should include the efforts made to obtain test results; some clinicians may document a time notation in the patient’s medical record as an estimate of the time and effort involved when limited audiologic information is obtained.

There may be a number of reasons why no audiologic results are obtained. However, in a situation where a child is completely uncooperative with any test procedure, the audiologist has a choice of cancelling the appointment altogether or using a reduced service modifier (-52) to indicate that the entire protocol associated with the diagnostic procedure was not completed.

What CPT codes should I use when testing middle ear function?

New CPT codes were created in 2010, at the request of the Centers for Medicare and Medicaid Services (CMS), to report middle ear function tests that were frequently performed together on the same date of service. Four distinct codes are now available:

• 92567 Tympanometry (impedance testing)
• 92568 Acoustic reflex testing, threshold
• 92550 Tympanometry and reflex threshold measurements
• 92570 Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing

The individual code for acoustic reflex decay testing (92569) was deleted at the time of the 2010 code changes.

If acoustic reflex threshold testing or acoustic reflex threshold testing and acoustic reflex decay testing are performed on the same date of service as tympanometry, you must report the bundled code that describes what has been performed. You may not report tympanometry (92567) and acoustic reflex threshold testing (92568) separately on the same date of service.

If I perform a 1000 Hz ipsilateral acoustic reflex screening along with tympanometry, can I use CPT code 92550 (Tympanometry and reflex threshold measurement)?

CPT has defined acoustic reflex threshold testing (92568 and 92550) as including both ipsilateral and contralateral acoustic reflex threshold measurements. There is not a CPT code available for acoustic reflex screening. Only the tympanometry code (92567) would be allowed in this instance.

Are there CPT codes for the new wideband reflectance and multi-frequency tympanometry tests?

New methods of assessing middle ear function are now available in clinical test equipment. Although these advanced middle ear test methods are becoming accepted as part of a clinical test battery, there are no current CPT codes for these tests.

The tympanometry-only code (92567) should be used if wideband reflectance or multi-frequency tympanometry tests are completed. The code is a session-based code, meaning that 92567 can only be billed one time per day, even if standard and multi-frequency tympanometry as well as wideband reflectance testing are all completed on the same day.

An extended service modifier (-22) could be considered when multi-frequency tympanometry and wideband reflectance testing are completed on the same day. Detailed documentation of the justification for the extended service should be included in the patient’s medical record.

What CPT codes should I use when I test otoacoustic emissions (OAE)?

There are three (3) OAE codes that clearly describe the differences between screening OAE and limited versus comprehensive OAE evaluation. The OAE codes assume that testing is completed in both ears.

• 92558 Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis
• 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

The OAE screening code (92558) should be billed when only an overall Pass/Fail result is obtained and no other interpretation is performed or reported.

The OAE limited evaluation code (92587) should be used when the purpose of the test is to evaluate hearing status. 92587 specifies that three (3) to six (6) Distortion Product (DPOAE) frequencies should be evaluated per ear. Transient Evoked OAE testing (TEOAE) is included in this code.

The OAE comprehensive evaluation code (92588) should be used when the purpose of the test is to evaluate outer hair cell function or to perform cochlear mapping for purposes such as ototoxic monitoring or tinnitus evaluation. 92588 specifies that 12 or more distortion product OAE frequencies should be evaluated per ear.

CPT Code

CPT Code - 92553

Description - Pure Tone Audiometry (Threshold); Air & Bone

Split PC/TC? - No

CPT Code - 92555

Description - Speech Audiometry Threshold

Split PC/TC? - No

CPT Code - 92556

Description - Speech Audiometry Threshold; w/Speech Recognition

Split PC/TC? - No

CPT Code - 92557

Description - Comprehensive Audiometry Threshold Eval & Speech R..

Split PC/TC? - No

CPT Code - 92567

Description - Tympanometry (Impedance Testing)

Split PC/TC? - No

CPT Code - 92568

Description - Acoustic reflex testing, threshold

Split PC/TC? - No

CPT Code - 92570

Description - Acoustic Immittance, Tympanometry

Split PC/TC? - No

CPT Code - 92579

Description - Visual Reinforcement Audiometry (VRA)

Split PC/TC? - No

CPT Code - 92601

Description - Diagnostic analysis of cochlear implant, patient younger...

Split PC/TC? - No

CPT Code - 92602

Description - …subsequent reprogramming

Split PC/TC? - No

CPT Code - 92603

Description - Diagnostic analysis of cochlear implant, age 7 years +…

Split PC/TC? - No

CPT Code - 92604

Description - …subsequent reprogramming

Split PC/TC? - No

CPT Code - 92561

Description - …Bekesy audiometry, diagnostic

Split PC/TC? - No

CPT Code - 92562

Description - Loudness balance test, alternate binaural or monaural

Split PC/TC? - No

CPT Code - 92563

Description - Tone decay test

Split PC/TC? - No

CPT Code - 92564

Description - Short increment sensitivity index (SISI)

Split PC/TC? - No

CPT Code - 92565

Description - Stenger test, pure tone

Split PC/TC? - No

CPT Code - 92571

Description - Filtered speech test

Split PC/TC? - No

CPT Code - 92572

Description - Staggered spondaic word test

Split PC/TC? - No

CPT Code - 92575

Description - Sensorineural acuity level test

Split PC/TC? - No

CPT Code - 92576

Description - Synthetic sentence identification test

Split PC/TC? - No

CPT Code - 92577

Description - Stenger test, speech

Split PC/TC? - No

CPT Code - 92582

Description - Conditioning play audiometry

Split PC/TC? - No

CPT Code - 92583

Description - Select picture audiometry

Split PC/TC? - No

CPT Code - 92584

Description - Electrocochleography

Split PC/TC? - No

CPT Code - 92585

Description - Auditory Evoked Potentials, Evoked Response

Split PC/TC? - Yes

CPT Code - 92586

Description - Auditory Evoked Potentials for Evoked Response; Limited

Split PC/TC? - Yes

CPT Code - 92587

Description - Evoked Otoacoustic Emissions; Limited

Split PC/TC? - Yes

CPT Code - 92588

Description - Evoked Otoacoustic Emissions; Comprehensive/Dx

Split PC/TC? - Yes

CPT Code - 92620

Description - Evaluation of central auditory function, with report; initial

Split PC/TC? - No

CPT Code - 92621

Description - …Each additional 15 minutes

Split PC/TC? - No

CPT Code - 92625

Description - Assessment of tinnitus (includes pitch, loudness matching..

Split PC/TC? - No

CPT Code - 92626

Description - Evaluation of auditory rehabilitation status; first hour

Split PC/TC? - No

CPT Code - 92627

Description - …Each additional 15 minutes

Split PC/TC? - No

CPT Code - 92640

Description - Diagnostic analysis with programming of auditory brain…

Split PC/TC? - No

Procedure Code Table - continued

CPT or HCPCS Procedure Code : 99215

Short Description: Office/outpatient visit est

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 99241

Short Description: Office consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99242

Short Description: Office consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99243

Short Description: Office consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99244

Short Description: Office consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99245

Short Description: Office consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99251

Short Description: Inpatient consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99252

Short Description: Inpatient consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99253

Short Description: Inpatient consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99254

Short Description: Inpatient consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99255

Short Description: Inpatient consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : L7510

Short Description: Prosthetic device repair rep

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8515
Short Description: Gel cap app device for trach

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8615
Short Description: Headpiece for cochlear implant

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8616
Short Description: Microphone for cochlear implant

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8617
Short Description: Transmit coil cochlear implant

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8618
Short Description: Transmit cable cochlear impl

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8619
Short Description: Coch imp ext proc/contr rplc

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8621
Short Description: Zinc air battery cochlear impl

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8622
Short Description: Alkaline battery cochlear imp

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8623
Short Description: Lith ion batt CID, non-ear lvl

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8624
Short Description: Lith ion batt CID, ear level

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8691
Short Description: Auditory osseointegrated device, external sound processor, replacement

Covered Benefit :Yes

Prior Authorization Needed: Yes

CPT or HCPCS Procedure Code : L8692
Short Description: Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment

Covered Benefit :Yes

Prior Authorization Needed: Yes

CPT or HCPCS Procedure Code : S0618
Short Description: Audiometry for hearing aid evaluation to determine the level and degree of hearing loss

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : S9152
Short Description: Speech therapy, re-eval

Covered Benefit :No

Prior Authorization Needed: -

Audiology CPT Code

CPT Code	Official CPT Description	Uses
92603	Diagnostic analysis of cochlear implant, age 7 years or older; with programming	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; add a ‐59 (distinct procedural service) if performed on the sale date of service as 92526.
92604	Diagnostic analysis of cochlear implant, age 7 years or older; with subsequent reprogramming	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; add a ‐59 (distinct procedural service) if performed on the sale date of service as 92526.
92620	Evaluation of central auditory function, with report; initial 60 minutes	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.
92621	Evaluation of central auditory function, with report; each additional 15 minutes	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.
92625	Assessment of tinnitus (includes pitch, loudness matching and masking)	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 (reduced services) modifier
92626	Evaluation of Auditory Rehabilitation Status; first hour	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

CPT Code	Official CPT Description	Uses
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 third‐ party payers who allow for payment; this code is used to report face to face time with the patient or family only
92630	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
92633	Auditory rehabilitation; post‐lingual hearing loss	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
92700	Unlisted otorhinolaryngological service or 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, euctachian tube function testing, VHiT, 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
95992	Canalith repositioning procedure(s) (eg Epley maneuver, Semont maneuver), per day	Do not use this code in conjunction with 92531 (Spontaneous nystagmus, including gaze, without recording) or 92532 (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

CPT Code	Official CPT Description	Uses
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	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
99368	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 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

TAGS: audiology cpt codes, cpt code 92587, cpt code 92546, 92537 cpt, cpt code 92552, cpt code for middle ear catheterization, cpt code for speech evaluation, cpt code for nasal function study, cpt 92585,