CPT code 92551 is used for a pure tone hearing test via air conduction, helping healthcare providers document and categorize this specific service.
CPT code 92551 is used to describe a pure tone hearing test conducted through air conduction. This procedure involves evaluating a patient's hearing ability by transmitting sound waves through the air to the ear canal, typically using headphones. The test measures the faintest tones a person can hear at various frequencies, helping to identify any hearing loss or auditory issues. This code is commonly used by audiologists and other healthcare providers to document and bill for basic hearing assessments.
For CPT code 92551, which pertains to a pure tone hearing test using air conduction, the following modifiers may be applicable:
1. Modifier 52 - Reduced Services: This modifier is used when the service or procedure is partially reduced or eliminated at the physician's discretion. If the hearing test is not performed in its entirety, Modifier 52 can be applied to indicate that the service was reduced.
2. Modifier 76 - Repeat Procedure by Same Physician: If the hearing test needs to be repeated on the same day by the same provider, Modifier 76 is used to indicate that the procedure was repeated.
3. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the hearing test is repeated on the same day by a different provider. Modifier 77 indicates that the procedure was repeated by another physician.
4. Modifier 59 - Distinct Procedural Service: Modifier 59 is used to indicate that the hearing test was a distinct service from other procedures performed on the same day. This is applicable when the test is performed in conjunction with other services that are not typically reported together.
5. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for laboratory tests, Modifier 91 can be applicable if the hearing test is repeated for clinical reasons on the same day to obtain additional information.
These modifiers help in accurately reporting the circumstances under which the hearing test was performed, ensuring proper billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can influence the use of modifiers.
CPT code 92551, which is associated with a pure tone hearing test air, is generally reimbursed by Medicare, but its reimbursement is subject to several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered under Medicare Part B, including those related to audiology services. To determine if CPT code 92551 is reimbursed, healthcare providers should consult the MPFS to verify its inclusion and the associated reimbursement rate.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and may have specific local coverage determinations (LCDs) that affect the reimbursement of certain CPT codes, including 92551. Providers should review the LCDs and any related guidance issued by their respective MAC to ensure compliance with Medicare's billing requirements and to confirm the reimbursement status of CPT code 92551.
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