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19.2.3 Audiological Testing
The CSHCN Services Program may reimburse physicians, APNs, and hospitals that provide hearing tests to clients of any age whose hearing is found to be suspect on the routine screening, whether or not hearing is found to be impaired.
Note: Hearing screenings may be included in a preventive care medical checkup. Refer to: Section 29.2.18.8, "Preventive Care Services" for information about preventive care medical checkups.
Audiological testing is also a benefit of the CSHCN Services Program for clients who are 21 years of age or older are not covered through PACT.
Note: Intermediate care facilities for the mentally retarded (ICF-MRs) are responsible for providing all supplies, equipment, medications, and physician services. The CSHCN Services Program does not reimburse for ICF-MR residents.
Comprehensive hearing tests (procedure code 92557) are benefits of the CSHCN Services Program and include the following tests:
• Pure tone screening test (procedure code 92551)
•Pure tone audiometry (procedure codes 92552 and 92553)
•Speech audiometry (procedure codes 2555 and 92556)
If three or more individual hearing tests are performed on the same day, the comprehensive hearing test procedure code (92557) must be billed. Claims for any combination of three or more tests that are billed separately with the same date of service are denied. Providers may not bill any of the individual testing procedure codes with the same date of service as procedure code 92557.
The following additional tests are also benefits of the CSHCN Services Program:
Procedure codes 92567 and 92568 are reimbursed for diagnostic purposes only.
Procedure codes 92587 and 92588 will not be reimbursed when billed with the same date of service by the same provider.
Tympanometry (impedance testing) may be considered for reimbursement as an objective diagnostic test of middle ear disease. Procedure code 92567 is limited to four services per year by the same provider.
Acoustic reflex testing procedure codes 92568 and 92569 are benefits when billed with one of the following diagnosis codes:
|
Diagnosis Code
|
Description
|
|
2251
|
Benign neoplasm of cranial nerves
|
|
3510
|
Bell's palsy
|
|
3511
|
Geniculate ganglionitis
|
|
3518
|
Other facial nerve disorders
|
|
3519
|
Unspecified facial nerve disorder
|
|
38600
|
Unspecified Meniere's disease
|
|
38601
|
Active Meniere's disease, cochleovestibular
|
|
38602
|
Active Meniere's disease, cochlear
|
|
38603
|
Active Meniere's disease, vestibular
|
|
38604
|
Inactive Meniere's disease
|
|
38610
|
Unspecified peripheral vertigo
|
|
38611
|
Benign paroxysmal positional vertigo
|
|
38612
|
Vestibular neuronitis
|
|
38619
|
Other and unspecified peripheral vertigo
|
|
3862
|
Vertigo of central origin
|
|
38630
|
Unspecified labyrinthitis
|
|
38631
|
Serous labyrinthitis
|
|
38632
|
Circumscribed labyrinthitis
|
|
38633
|
Suppurative labyrinthitis
|
|
38634
|
Toxic labyrinthitis
|
|
38635
|
Viral labyrinthitis
|
|
38640
|
Unspecified labyrinthine fistula
|
|
38641
|
Round window fistula
|
|
38642
|
Oval window fistula
|
|
38643
|
Semicircular canal fistula
|
|
38648
|
Labyrinthine fistula of combined sites
|
|
38650
|
Unspecified labyrinthine dysfunction
|
|
38651
|
Hyperactive labyrinth, unilateral
|
|
38652
|
Hyperactive labyrinth, bilateral
|
|
38653
|
Hypoactive labyrinth, unilateral
|
|
38654
|
Hypoactive labyrinth, bilateral
|
|
38655
|
Loss of labyrinthine reactivity, unilateral
|
|
38656
|
Loss of labyrinthine reactivity, bilateral
|
|
38658
|
Other forms and combinations of labyrinthine dysfunction
|
|
3868
|
Other disorders of labyrinth
|
|
3869
|
Unspecified vertiginous syndromes and labyrinthine disorders
|
|
3870
|
Otosclerosis involving oval window, nonobliterative
|
|
3871
|
Otosclerosis involving oval window, obliterative
|
|
3872
|
Cochlear otosclerosis
|
|
3878
|
Other otosclerosis
|
|
3879
|
Unspecified otosclerosis
|
|
3882
|
Unspecified sudden hearing loss
|
|
38830
|
Unspecified tinnitus
|
|
38831
|
Subjective tinnitus
|
|
38832
|
Objective tinnitus
|
|
38840
|
Unspecified abnormal auditory perception
|
|
38841
|
Diplacusis
|
|
38842
|
Hyperacusis
|
|
38843
|
Impairment of auditory discrimination
|
|
38844
|
Other abnormal auditory perception, recruitment
|
|
38845
|
Acquired auditory processing disorder
|
|
3885
|
Disorders of acoustic nerve
|
|
38905
|
Conductive hearing loss, unilateral
|
|
38906
|
Conductive hearing loss, bilateral
|
|
38913
|
Neural hearing loss, unilateral
|
|
38915
|
Sensorineural hearing loss, unilateral
|
|
38916
|
Sensorineural hearing loss, asymmetrical
|
|
38917
|
Sensory hearing loss, unilateral
|
|
38920
|
Mixed hearing loss, unspecified
|
|
38921
|
Mixed hearing loss, unilateral
|
|
38922
|
Mixed hearing loss, bilateral
|
|
7443
|
Unspecified congenital anomaly of ear
|
|
7804
|
Dizziness and giddiness
|
|
