CPT code 92556 is used for a comprehensive speech audiometry test, assessing a patient's ability to hear and understand speech.
CPT code 92556 is used to describe a comprehensive evaluation of a patient's speech audiometry. This procedure involves assessing the patient's ability to recognize and understand speech, typically conducted in a controlled environment using standardized speech materials. The test measures the patient's speech reception threshold (SRT) and speech discrimination or word recognition ability, which are crucial for diagnosing hearing impairments and planning appropriate treatment or interventions. This code is often utilized by audiologists and other hearing specialists to ensure accurate billing and documentation of the services provided.
For CPT code 92556, which pertains to speech audiometry complete, 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 speech audiometry service required significantly more effort or time than typically required. Documentation must support the substantial additional work.
2. Modifier 52 - Reduced Services: Apply this modifier if the service was partially reduced or eliminated at the discretion of the provider. This might occur if only part of the speech audiometry was completed due to patient limitations or other factors.
3. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Use this modifier if the same provider needs to repeat the speech audiometry test on the same day for the same patient.
4. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is applicable if a different provider repeats the speech audiometry test on the same day for the same patient.
5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the speech audiometry service was distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although less common for audiometry, this modifier might be used if the 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 speech audiometry service is provided via telemedicine, this modifier indicates that the service was rendered through a real-time interactive audio and video system.
Each modifier should be used in accordance with payer policies and specific clinical scenarios. Proper documentation is crucial to justify the use of any modifier.
CPT code 92556, which is associated with speech audiometry complete, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines whether a particular CPT code is reimbursable and at what rate. The MPFS outlines the payment rates for services provided to Medicare beneficiaries, and CPT code 92556 is included in this schedule.
However, the reimbursement for CPT code 92556 can also depend on the specific Medicare Administrative Contractor (MAC) that processes claims in your region. MACs have the authority to establish local coverage determinations (LCDs) that may influence the reimbursement criteria for certain services. Therefore, while CPT code 92556 is generally reimbursable under Medicare, healthcare providers should verify the specific guidelines and coverage policies set forth by their regional MAC to ensure compliance and proper reimbursement.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level. With RevFind, you can identify discrepancies for specific services, such as CPT code 92556, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can optimize your revenue recovery process.
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