Tympany - Coding and Reimbursement

Coding & Reimbursement

CPT Codes for Hearing Evaluations
The following four CPT codes are billed when conducting a Hearing Evaluation. These are the same codes that audiologists and ENT physicians use today. The average national Medicare reimbursement and reimbursement range for commercial insurers have been included below. The reimbursement range for "Other Insurers" has been calculated from practices where the Otogram™ is in use.

CPT Code

Description of Full Hearing Evaluation*

Average
2003
US Medicare

Other
Insurers

92557

Comprehensive Audiogram (pure tone air & bone conduction, speech reception, and speech discrimination)

$50

$50-72

92567

Tympanometry

$22

$23-26

92568

Acoustic Reflex Test

$16

$17-22

92587

Otoacoustic Emissions (OAE)

$62

$80-125

Total

$150

$158-245

Most Common ICD-9 Codes that Support Medical Necessity
Dozens of ICD-9 codes can be used to support the medical necessity of hearing testing. The most common are listed below:

388.40	Hearing Loss, Unspecified
389.00	Conductive Hearing Loss
389.10	Sensorineural Hearing Loss
389.20	Mixed Hearing Loss
388.30	Tinnitus Unspecified
389.12	Neural Hearing Loss

The Otogram™ - A Diagnostic Tool
Most insurers will not pay for “screening” the hearing of a patient. Screening is typically defined as performing a procedure on a patient without a prior indication that a problem may exist. Diagnostic hearing testing is reimbursed however, and the Otogram™ is a diagnostic tool. As such, payers will reimburse for testing when the clinician documents that a patient has notified them of a hearing problem. The clinician documents this in the physician’s note along with an appropriate ICD-9 code on the insurance claim.

Modifier 25 – “A Separately Identifiable Service”
As with all CPT procedure codes published by the AMA, the procedures performed by the OtogramTM can in some cases require modifier 25 to assure reimbursement from Medicare, Medicaid and other payers. If a patient comes in specifically for a hearing test with no E&M service, modifier 25 is not required. If a physician sees a patient for an E&M service and it is determined that the patient also needs a hearing test, the physician can use modifier 25 to notify the insurer that the patient received a separate and distinct procedure apart from the E&M visit. In these cases, the ICD-9 for the E&M visit (i.e. a headache) must be different than the ICD-9 for the hearing test (i.e. Tinnitus, ringing in ears).