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23.3.3 Audiological Testing
Audiometry is the testing of a person's ability to hear various sound frequencies and is performed with the use of electronic equipment. Audiometry is used to identify and diagnose hearing loss.
Air and bone pure tone audiometry threshold testing assesses air and bone conduction. Speech reception threshold (SRT) and word recognition tests indicate the softest level that a person is able to hear and repeat two-syllable words, and how well a person can repeat words presented at a comfortable listening level. Speech audiometry uses a series of simple recorded words spoken at various volumes into headphones worn by the person being tested. The person repeats each word back as it is heard.
Procedure code 5-92557 is a comprehensive code. If any of the following procedure codes are submitted with the same date of service as procedure code 5-92557, they are denied as part of another service:
If three or more of the procedure codes listed above are submitted for reimbursement with the same date of service, they are denied with instructions to submit the appropriate audiometry procedure code (5-92557).
Procedure codes 5-92563, 5-92567, 5-92568, and 5-92569 are diagnostic hearing procedures that may be considered for reimbursement separately.
Tympanometry impedance testing (procedure code 5-92567) should never be used as the sole clinical means to establish the presence or absence of acute or chronic middle ear effusion or infection. Direct otoscopic examination by a suitably qualified provider, with or without pneumatic otoscopy, is the key element of the standard method used to establish a diagnosis of middle ear disease.
Tympanometry must be limited to selected individual cases where its use demonstrably adds to the provider's ability to establish a diagnosis and provide appropriate treatment. Tympanometry is limited to four services per year by the same provider and is based on medical necessity. Medical necessity must be documented in the patient's medical record. Tympanometry does not meet the requirements for a sensory screening component of the THSteps medical check up.
Acoustic reflex testing (procedure codes 5-92568 and 5-92569) provides information about the middle ear, specifically middle ear muscle reflexes in response to sound. The test can help distinguish between sensory (cochlear) hearing loss and neural (retro-cochlear) hearing loss. Acoustic reflex testing (procedure codes 5-92568 and 5-92569) is limited to the following diagnosis codes:
Evoked response testing includes the following procedures:
• ABR, also called brainstem evoked potential (BSER), audiometry is a procedure in which neural discharges from the auditory pathways are measured with surface electrodes situated on the scalp.
•Otoacoustic emissions (OAE) measures response from the cochlea.
Procedure codes 5-92585, 5-92586, 5/I/T-92587, and 5/I/T-92588 may be submitted for evoked response testing.
Each evoked potential test is considered a bilateral procedure. If separate charges are submitted for left- and right-sided tests of the same type, the tests will be combined and considered a quantity of one.
An electroencephalogram (EEG) submitted with the same date of service as an evoked response test is considered for reimbursement at the full reimbursement rate. Evoked response testing is also considered for reimbursement at the full reimbursement rate.
Procedure code 1-95920 is considered for reimbursement in addition to each evoked potential test. Procedure code 1-95920 is limited to a maximum of two hours each day, regardless of provider, without documentation of medical necessity.
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