CPT CODES

CPT Code 92559

CPT code 92559 is used for group audiometric testing, which assesses hearing ability in a group setting.

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What is CPT Code 92559

CPT code 92559 is used to describe group audiometric testing. This code is applied when a healthcare provider conducts hearing tests on multiple patients simultaneously. Group audiometric testing is typically used in settings where efficiency is needed, such as schools or community health screenings, to assess the hearing capabilities of several individuals at once. The results help identify any hearing impairments that may require further evaluation or intervention.

Does CPT 92559 Need a Modifier?

For CPT code 92559, which pertains to group audiometric testing, the following modifiers may be applicable:

1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide a service is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.

2. Modifier 52 - Reduced Services: This modifier is applicable when a service or procedure is partially reduced or eliminated at the physician's discretion. It indicates that the service provided was less than what is typically required.

3. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by the same provider subsequent to the original procedure or service.

4. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This is used when a procedure or service is repeated by a different provider than the one who originally performed the service.

5. 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 is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.

6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used when it is necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results.

These modifiers help provide additional information about the circumstances under which the service was provided, ensuring accurate billing and reimbursement. Proper documentation is essential when using modifiers to justify their application.

CPT Code 92559 Medicare Reimbursement

CPT code 92559 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in establishing the payment rates for services covered under Medicare Part B, including audiometric testing. However, whether CPT code 92559 is reimbursed can also depend on the specific policies of the Medicare Administrative Contractor (MAC) that processes claims in your geographic region. MACs have the authority to implement Local Coverage Determinations (LCDs) that may affect the reimbursement of certain services. Therefore, it is essential for healthcare providers to verify the specific guidelines and coverage criteria set forth by their respective MAC to ensure compliance and proper reimbursement for CPT code 92559.

Are You Being Underpaid for 92559 CPT Code?

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