CPT code 92553 is used for procedures involving audiometry tests that assess both air and bone conduction in patients.
CPT code 92553 is used to describe a procedure that involves audiometry testing by both air and bone conduction. This code is typically utilized by audiologists or healthcare providers to assess a patient's hearing ability. The test measures how well sound travels through the air (air conduction) and through the bones of the skull (bone conduction) to determine the type and degree of hearing loss. By comparing the results from both methods, healthcare providers can better diagnose and develop treatment plans for hearing impairments.
For CPT code 92553, which pertains to audiometry air and bone, the following modifiers may be applicable depending on the specific circumstances of the service provided:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the audiometry service required significantly more effort or time than typically necessary. Documentation must support the increased complexity.
2. Modifier 52 - Reduced Services: Apply this modifier if the audiometry service was partially reduced or not fully completed. This might occur if only air conduction or bone conduction was performed, rather than both.
3. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the audiometry test needs to be repeated on the same day by the same provider due to clinical necessity.
4. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the audiometry test is repeated on the same day by a different provider, again due to clinical necessity.
5. Modifier 59 - Distinct Procedural Service: This modifier is applicable when the audiometry service is performed in conjunction with another procedure, and it is necessary to indicate that the services are distinct and separate.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for laboratory tests, this modifier can be applicable if the audiometry test is repeated for clinical reasons, such as verifying results.
7. Modifier 95 - Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System: If the audiometry service is provided via telemedicine, this modifier may be used to indicate the method of service delivery.
Each modifier should be used with careful consideration of the specific circumstances and payer requirements, ensuring that documentation supports the use of any modifier applied.
CPT code 92553, which involves audiometry air and bone, is reimbursed by Medicare, subject to specific conditions and guidelines. The reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries. However, the actual reimbursement can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to interpret national policies and establish local coverage determinations (LCDs) that may affect the reimbursement of CPT code 92553. Therefore, healthcare providers should consult their specific MAC for detailed information on coverage and reimbursement rates for this service.
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