Audiology billing Guide - CPT code list - payment guidelines

Policy Definition

Audiology is the study of hearing and hearing disorders and includes habilitation and rehabilitation for individuals who have hearing loss

Provider Billing Guidelines and Documentation Coding

Code Description Comments

92550–92588 Audiometric tests Bill once with a count of one

92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech

92601–92604 Diagnostic analysis of cochlear implant; with programming; subsequent reprogramming

92605 Evaluation for prescription of non speech generating augmentative and alternative communication device Reimbursed for facility only

92606 Therapeutic service(s) for the use of non speech generating device, including programming and modification

92607–92609 Speech generating and non-speech generating augmentativeand alternative communication device-related services
To bill professional component of service use CPT; to bill DME component, refer to Durable Medical Equipment (DME).

92620, 92621 Evaluation of central auditory function, with report

92625 Assessment of tinnitus

92626 Evaluation of auditory rehabilitation status; first hour

92627 Evaluation of auditory rehab status; ea add’l 15 minutes Bill in conjunction with 92626

92630 Auditory rehabilitation; pre-lingual hearing loss

92633 Auditory rehabilitation; post-lingual hearing loss

 92700 Unlisted otorhinolaryngological service or procedure Submit documentation of services rendered


Modifiers

• When billing for monaural hearing aids, a RT or LT modifier in the second modifier field is required for payment. Claims submitted without the RT or LT modifier may be denied.

• When billing for a binaural hearing aid the RT or LT modifier is not required. Claims submitted with a RT or LT modifier will be denied as inappropriately billed.


AUDIOLOGY SERVICES  Payable Codes to Audiologists

SERVICE DESCRIPTION CODE

Spontaneous Nystagmus; w/record 92541

Positional Nystagmus; w/record 92542

Caloric Vestibular Test; w/record 92543

Optokinetic Nystagmus; w/record 92544

Oscillating Tracking; w/record 92545

Use of Vertical Electrodes 92547

Screening Test, Pure Tone, Air Only 92551

Pure Tone Audiometry; Air Only 92552

Pure Tone Audiometry; Air and Bone 92553

Speech Audiometry Threshold 92555

Speech Audiometry Threshold; with speech recognition 92556

Comprehensive Audiometry 92557

Tone Decay Test 92563

Short Increment Sensitivity Index 92564

Stenger Test, Pure Tone 92565

Tympanometry 92567

Acoustic Reflex Testing; Threshold 92568

Acoustic Reflex Testing; Decay 92569

Filtered Speech Test 92571

Staggered Spondaic Word Test 92572

Sensorineural Acuity Level Test 92575

Synthetic Sentence ID Test 92576

Stenger Test, Speech 92577

Visual Reinforcement Audiometry (VRA) 92579

Conditioning Play Audiometry 92582

Select Picture Audiometry 92583

Electrocochleography 92584

Auditory Evoked Potentials; Comprehensive 92585

Auditory Evoked Potentials; Limited 92586

Evoked Otoacoustic Emissions; Limited 92587

Evoked Otoacoustic Emissions; Comprehensive 92588

Hearing Aid Exam/Selection; Monaural 92590

Hearing Aid Exam/Selection; Binaural 92591

Hearing Aid Check; Monaural 92592

Hearing Aid Check; Binaural 92593

Electroacoustic Evaluation Hearing Aid; Monaural 92594

Electroacoustic Evaluation Hearing Aid; Binaural 92595

Evaluation of Central Auditory Function w/report; init 60 Min 92620

Evaluation of Central Auditory Function; ea additional 15 Min 92621

Assessment of Tinnitus Assessment 92625



Restrictions

• Payment for the following codes is restricted to one each per recipient per 180 days

92552 92553 92555 92556 92557 92563 92564 92565 92567 92568 92569 92571 92572 92575 92576 92577 92579 92582 92583 92584 92585

• Audiologist are reminded that for recipients in the CommunityCARE program, there must be a written authorization from the recipient’s PCP for the audiologist’s services. This includes recipients that are referred to them by the Head Start program.



Audiologists Employed by Hospitals 

Audiologists who are salaried employees of hospitals cannot bill Medicaid for their professional services rendered at that hospital because their services are included in the hospital’s per diem rate. Audiologists can enroll and bill Medicaid if they are providing services at a hospital at which there is no audiologist on staff.

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