Audiology services refer to hearing and balance evaluations provided by a licensed audiologist.
Because audiologists have their own Medicare coverage that permits them to bill for audiology services they personally provide, audiology services are not covered under the benefit for services “incident to” a physician’s treatment.
In all contexts, a physician’s order is required for audiology services.
The rationale for the testing, rather than the patient’s diagnosis or condition, determines coverage for audiology services.
CMS published the Notice of Proposed Rule Making for the CY 2022 Medicare Physician Fee Schedule on July 13, 2021. (MPFS).
|7.13.21||CY 2022 Proposed Medicare Physician Fee Schedule – Initial Calculations of Proposed Payment Rates for Audiology Services|
|CPT Code||Descriptor||MPFS Final 2021||MIPS Proposed 2022||Difference Final 2021 vs Proposed 2022|
|92537||Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool irrigation in each ear for a total of four irrigations)||$39.86||$39.29||($0.57)|
|92538||Caloric vestibular test with recording, bilateral; monothermal (ie, one irrigation in each ear for a total of two irrigations)||$21.71||$21.49||($0.22)|
|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||$105.33||$103.78||($1.55)|
|92541||Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording||$24.31||$24.52||$0.21|
|92542||Positional nystagmus test, minimum of 4 positions, with recording||$28.20||$28.21||$0.01|
|92544||Optokinetic nystagmus test, bidirectional, foveal or||$17.18||$17.46||$0.28|
|92545||Oscillating tracking test, with recording||$16.21||$16.12||($0.09)|
|92546||Sinusoidal vertical axis rotational testing||$117.32||$134.34||$17.02|
|92547||Use of vertical electrodes (List separately in addition to||$9.72||$9.40||($0.32)|
|92548||Computerized dynamic posturography sensory organization test (CDPSOT), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report||$47.97||$47.02||($0.95)|
|92549||Computerized dynamic posturography sensory organization test (CDPSOT), 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)||$60.93||$61.79||$0.86|
|92550||Tympanometry and reflex threshold measurements||$21.39||$21.83||$0.44|
|92551||Pure tone hearing test air – non covered||$11.34||$13.10||$1.26|
|92552||Pure tone audiometry (threshold); air only||$31.76||$40.64||$8.88|
|92553||Pure tone audiometry (threshold); air and bone||$38.57||$50.04||$11.47|
|92555||Speech audiometry threshold;||$23.98||$30.56||$6.58|
|92650||Aep scr auditory potential – non covered||$27.55||$25.86||($1.69)|
|92651||Aep broadband with i&r||$85.56||$82.62||($2.94)|
|92652||Aep thrshld est mlt freq i&r||$119.39||$109.15||($10.24)|
|92653||Aep neurodiagnostic i&r||$83.29||$80.27||($3.02)|
|92517||Vemp test i&r cervical||$81.35||$78.59||($2.76)|
|92518||Vemp test i&r ocular||$75.51||$73.55||($1.96)|
|92519||Vemp tst i&r cervical&ocular||$126.72||$122.92||($3.80)|
|92556||Speech audiometry threshold; with speech recognition||$37.92||$49.03||$11.11|
|92557||Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined)||$35.98||$36.27||$0.29|
|92560||Bekesy audiometry; screening||$0.00||deleted code|
|92561||Bekesy audiometry; diagnostic||$39.22||deleted code|
|92562||Loudness balance test, alternate binaural or monaural||$44.72||$52.39||$7.67|
|92563||Tone decay test||$30.79||$35.93||$5.14|
|92564||Short increment sensitivity index (SISI)||$23.66||deleted code|
|92565||Stenger test, pure tone||$16.85||$23.51||$6.66|
|92567||Tympanometry (impedance testing)||$15.88||$15.45||($0.43)|
|92568||Acoustic reflex testing, threshold||$14.90||$15.45||$0.55|
|92570||Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing||$31.11||$31.90||$0.79|
|92571||Filtered speech test||$26.58||$35.26||$8.68|
|92572||Staggered spondaic word test||$35.97||$51.05||$15.08|
|92575||Sensorineural acuity level test||$66.44||$81.27||$14.83|
|92576||Synthetic sentence identification test||$35.97||$47.02||$11.05|
|92577||Stenger test, speech||$15.23||$23.17||$7.94|
|92579||Visual reinforcement audiometry (VRA)||$44.08||$44.33||$0.25|
|92582||Conditioning play audiometry||$72.60||$95.04||$22.44|
|92583||Select picture audiometry||$48.94||$62.13||$13.19|
|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||$21.07||$21.16||$0.09|
|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||$32.41||$32.91||$0.51|
|92601||Diagnostic analysis of cochlear implant, patient younger than 7 years of age; with programming||$157.51||$155.83||($1.68)|
|92602||Diagnostic analysis of cochlear implant, patient younger than 7 years of age; subsequent reprogramming||$100.47||$98.07||($2.40)|
|92603||Diagnostic analysis of cochlear implant, age 7 years or older; with programming||$147.14||$146.76||($0.38)|
|92604||Diagnostic analysis of cochlear implant, age 7 years or older; subsequent programming||$89.45||$87.99||($1.46)|
|92620||Evaluation of central auditory function, with report; initial 60 minutes||$88.48||$88.33||($0.15)|
|92621||Evaluation of central auditory function, with report; each additional 15 minutes (List separately in addition to code for primary procedure)||$21.07||$21.49||$0.42|
|92625||Assessment of tinnitus (includes pitch, loudness matching, and masking)||$65.79||$66.83||$1.04|
|92626||Evaluation of auditory rehabilitation status; first hour||$85.24||$85.64||$0.40|
|92627||Evaluation of auditory rehabilitation status; each additional 15 minutes (List separately in addition to code for primary procedure)||$20.09||$20.15||$0.06|
|92640||Diagnostic analysis with programming of auditory brainstem implant, per hour||$107.60||$108.14||$0.54|
The following changes to Current Procedural Terminology (CPT ® American Medical Association) and Healthcare Common Procedures Coding System (HCPCS) Level II codes for audiology services will take effect on January 1, 2022.
Deleted CPT Codes
The following four CPT codes are deleted effective January 1, 2022.
|92559||Audiometric testing of groups|
|92560||Bekesy audiometry; screening|
|92561||Bekesy audiometry; diagnostic|
|92564||Short increment sensitivity index (SISI)|
New Remote Monitoring CPT Codes
The following new CPT codes are effective January 1, 2022.
|98975||Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment|
|98976||Device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days|
|98977||Device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days|
|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|
|98981||Each additional 20 minutes (listed separately in addition to code for primary procedure)|
Both ears are tested in Audiologic Function Tests (Codes 92550 through 92700).
Modifier 52 (Reduced Services) should be used if only one ear is being examined rather of both.
The use of 92601-92604, which entails the post-operative analysis, fitting, and adjustments of a cochlear implant, is the only exception.