CPT code 92557 is used for a comprehensive hearing test, covering a full evaluation of hearing function and auditory health.
CPT code 92557 is used to describe a comprehensive hearing test, which is a thorough evaluation of a patient's hearing ability. This code encompasses a battery of tests that assess various aspects of auditory function, including air and bone conduction thresholds, speech reception thresholds, and speech discrimination scores. The comprehensive nature of this test allows healthcare providers to diagnose hearing loss accurately and determine the appropriate treatment or intervention. This code is typically used by audiologists and other hearing specialists in clinical settings.
For CPT code 92557, which pertains to a comprehensive hearing test, 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 comprehensive hearing test 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 comprehensive hearing test was partially completed or if certain components of the test were not performed. This indicates that the service was reduced at the discretion of the provider.
3. Modifier 76 - Repeat Procedure by Same Physician or Other Qualified Health Care Professional: Use this modifier if the comprehensive hearing 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 or Other Qualified Health Care Professional: This modifier is applicable if the comprehensive hearing 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 used to indicate that the comprehensive hearing test 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 hearing tests, this modifier can be used if the test is repeated on the same day to obtain subsequent results due to clinical necessity.
7. Modifier GA - Waiver of Liability Statement Issued as Required by Payer Policy: Use this modifier if an Advance Beneficiary Notice (ABN) was issued to the patient, indicating that the test may not be covered by insurance.
8. Modifier GY - Item or Service Statutorily Excluded or Does Not Meet the Definition of Any Medicare Benefit: This modifier is used when the service is not covered by Medicare, and the provider wants to indicate that the service is statutorily excluded.
Each modifier should be used in accordance with payer policies and guidelines, and proper documentation should be maintained to support the use of any modifier.
CPT code 92557 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services covered under Medicare Part B, and CPT code 92557 is listed among those services. However, the reimbursement rate and coverage specifics can vary based on geographic location and other factors. These variations are managed by Medicare Administrative Contractors (MACs), which are responsible for processing claims and determining local coverage decisions. Healthcare providers should consult their specific MAC for detailed information on reimbursement rates and any additional requirements or documentation needed for CPT code 92557.
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