CPT code 92552 is used for pure tone audiometry air testing, which measures hearing sensitivity across different frequencies.
CPT code 92552 is used to describe the procedure of pure tone audiometry conducted through air conduction. This diagnostic test is performed to evaluate an individual's hearing ability by measuring their response to sounds transmitted through the air. The test involves using headphones to deliver a series of tones at various frequencies and intensities to each ear separately. The results help healthcare providers determine the degree and type of hearing loss, which is crucial for developing an appropriate treatment plan or recommending hearing aids if necessary.
For CPT code 92552, which pertains to pure tone audiometry air, the following modifiers may be applicable depending on the specific circumstances of the service provided:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the test results, not the technical component.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the use of equipment and technician services, excluding the professional interpretation.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It may be necessary if multiple audiometric tests are performed and need to be distinguished from one another.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same provider on the same day. It indicates that the repeat procedure was necessary and not a duplicate billing error.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different provider on the same day. It indicates that the repeat procedure was necessary and not a duplicate billing error.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for laboratory tests, this modifier can sometimes be applicable if the audiometry test needs to be repeated for clinical reasons, such as verifying initial results.
These modifiers should be used appropriately to ensure accurate billing and reimbursement, reflecting the specific circumstances under which the audiometry service was provided. Always verify payer-specific guidelines, as they may have unique requirements for modifier usage.
CPT code 92552 is reimbursed by Medicare, but its reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the payment rates for each service. However, the actual reimbursement for CPT code 92552 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). MACs are responsible for processing Medicare claims and have the authority to make coverage decisions within their jurisdiction. Therefore, healthcare providers should consult their local MAC for detailed information on the reimbursement criteria and any potential coverage limitations for CPT code 92552.
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