Coding for Evaluation of Auditory Rehabilitation Status

CPT Codes 92626 and 92627

The content in this Q & A was compiled in collaboration with the Academy of Doctors of Audiology (ADA), the American Academy of Audiology (AAA), and the American Speech-Language-Hearing Association (ASHA).

There has been confusion regarding the appropriate use of Current Procedural Terminology (CPT ® American Medical Association) codes related to the evaluation of auditory rehabilitation status. The guidance below is based on an article, "Coding Brief: Evaluation of Auditory Rehabilitation Status (92626)," from the July 2014 issue of CPT Assistant, which is published by the American Medical Association and considered an authoritative source for coding guidance. These codes have coverage and noncoverage applications, and audiologists will need to validate coverage with their individual payers.

The codes addressed in the CPT Assistant article are:

• 92626 Evaluation of auditory rehabilitation status; first hour
• 92627 Evaluation of auditory rehabilitation status; each additional 15 minutes

Questions & Answers

• When is it appropriate to use CPT codes 92626 and 92627?
• Do these codes capture other services related to hearing aids or cochlear implants?
• When can I use 92626 and 92627 with commercial payers?
• Can I use the codes for patient and/or family counseling?
• How do I bill these codes if the evaluation lasts more or less than an hour?
• If the evaluation is 30 minutes or less, can I report 92627 alone or report 92626 with the -52 modifier?

When is it appropriate to use CPT codes 92626 and 92627?

Audiologists may report CPT codes 92626 and 92627 when evaluating the auditory function of a patient either before or after the patient receives a unilateral or bilateral hearing device(s), including

• hearing aid(s),
• auditory osseointegrated implant(s),
• middle-ear implant(s),
• cochlear implant(s), and/or
• auditory brainstem implants.

According to the July 2014 issue of the CPT Assistant, the "evaluation will determine the need for auditory rehabilitation following the fitting and verification of hearing devices and may also be used to monitor the progress of therapeutic intervention."

Do these codes capture other services related to hearing aids or cochlear implants?

No. CPT Assistant is clear that it is inappropriate to use 92626 and 92627 for services other than the evaluation of auditory function to determine the need for rehabilitation. The items below provide guidance on appropriate coding for other commonly reported services related to hearing aids and cochlear implants:

• Hearing aid examination and selection should be coded using 92590 (monaural), 92591 (binaural), or V5010.
• Fitting, orientation, and checking of a hearing aid are reported using Health Care Common Procedure Code System (HCPCS) code V5011.
• Hearing aid checks are reported using 92592 or 92593.
• Hearing aid verification and validation are reported using V5020.
• Hearing aid dispensing fees are reported using one of the following HCPCS codes: V5090, V5110, V5160, V5200, V5240, or V5241.
• Diagnostic analysis and programming/reprogramming services related to cochlear implants are reported with CPT codes 92601 through 92604.
• Cochlear implant troubleshooting is reported using 92700 or L9900.
• Aural rehabilitation is reported using 92630 or 92633.
• Tinnitus evaluation is reported using 92625.

When can I use 92626 and 92627 with commercial payers?

Commercial payers may have different policies on the medical necessity and coverage of the evaluation of aural rehabilitation status. Coverage policies may also vary for the same payer depending on the type of plan. Billing practices and coverage policies for these CPT codes should be verified with the commercial payer.

Can I use the codes for patient and/or family counseling?

This is not considered an appropriate use of 92626 and 92627. The audiologist's time spent in counseling is not separately reportable to Medicare. Audiologists should consult non-Medicare payers before separately coding for time spent counseling.

How do I bill these codes if the evaluation lasts more or less than an hour?

CPT Assistant states that 92626 "is a time-based code and is reported for the first hour of evaluation. Code 92626 should not be reported for evaluations of auditory function lasting less than 31 minutes. Add-on code 92627 is reported for each additional 15 minutes of evaluation and must be used in conjunction with code 92626 for evaluations lasting longer than 60 minutes."

"When reporting codes 92626 and 92627, the documented time spent face to face with the patient or family should be used to determine the length of the auditory rehabilitation evaluation." It is important for providers to clearly document in the patient's medical record the time spent providing the evaluation service (e.g., start and stop time).

If the evaluation is 30 minutes or less, can I report 92627 alone or report 92626 with the -52 modifier?

No, the add-on code 92627 cannot be billed independently of 92626 and cannot be used for instances when the documented time spent in evaluation is less than 31 minutes. The reduced service modifier (-52) cannot be used with any time-based procedure codes.

If the time spent for the evaluation is less than 30 minutes, 92700 (Unlisted otorhinolaryngological service or procedure) may be reported. However, when a claim that includes 92700 is filed, it will be necessary to submit supporting documentation detailing the need for the service, as well as the time, effort, and equipment necessary to provide the service.