CPT code 92564 is used for a Sisi hearing test, which evaluates a patient's ability to detect small changes in sound intensity.
CPT code 92564 is used to describe the Sisi hearing test, which is a specialized audiological procedure. This test is designed to assess a patient's ability to detect small changes in loudness, which can be particularly useful in diagnosing certain types of hearing loss, such as cochlear or sensorineural hearing loss. During the Sisi hearing test, a series of tones are presented to the patient at varying intensities, and the patient's responses help audiologists determine the specific characteristics of their hearing impairment. This information is crucial for developing an effective treatment plan or for further diagnostic evaluation.
For the CPT code 92564, which pertains to the Sisi hearing test, 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 the professional component of the service is being billed separately from the technical component. It indicates that the provider is billing only for the interpretation of the test results.
2. Modifier TC - Technical Component: This modifier is used when the technical component of the service is being billed separately. It indicates that the provider is billing only for the use of equipment and technician services.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure or service was distinct or independent from other services performed on the same day. It is used when the Sisi hearing test is performed in conjunction with other procedures that are not typically reported together.
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 test was necessary to be repeated for valid clinical reasons.
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 test was necessary to be repeated for valid clinical reasons by another provider.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for laboratory tests, this modifier can be applicable if the Sisi hearing test is repeated on the same day for the same patient to obtain additional information.
These modifiers should be used appropriately to ensure accurate billing and reimbursement, reflecting the specific circumstances under which the Sisi hearing test was performed. Always verify with current payer policies and guidelines, as they can vary.
CPT code 92564, which is associated with the Sisi hearing test, is not reimbursed by Medicare. According to the Medicare Physician Fee Schedule (MPFS), this particular code is not listed, indicating that it is not covered for reimbursement under standard Medicare policies.
Additionally, Medicare Administrative Contractors (MACs), which are responsible for processing claims and determining coverage specifics in their respective jurisdictions, typically follow the guidelines set forth by the MPFS. Therefore, healthcare providers should be aware that claims submitted for CPT code 92564 are likely to be denied by Medicare, and alternative billing strategies or patient payment options may need to be considered.
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