CPT code 92565 is used for the Stenger test, a procedure to assess hearing by determining if a person is experiencing unilateral hearing loss.
CPT code 92565 is used to describe the Stenger test for pure tone. This test is an audiological procedure employed to determine the presence of unilateral (one-sided) hearing loss, particularly when there is a suspicion of non-organic hearing loss or malingering. During the Stenger test, different tones are presented simultaneously to both ears, with the tone in the better-hearing ear being slightly louder. If the patient does not respond, it suggests that they are hearing the tone in the poorer ear, indicating that the hearing loss may not be genuine. This code is essential for audiologists and healthcare providers to accurately document and bill for the procedure when assessing hearing capabilities.
For the CPT code 92565, which pertains to the Stenger test for pure tone, 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 only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the test results rather than the technical component.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the use of equipment and the technician's time, excluding the interpretation.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It may be necessary if the Stenger test is performed in conjunction with other audiological tests to ensure proper reimbursement.
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 may apply if the Stenger test needs to be repeated for accuracy or confirmation.
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 may apply if a second opinion or confirmation is required.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for laboratory tests, this modifier can be applicable if the Stenger test is repeated for clinical reasons, such as verifying initial results.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the service rendered. It is essential to use them appropriately to avoid claim denials or delays.
CPT code 92565, which is associated with the Stenger test pure tone, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource for determining whether a specific CPT code is reimbursable and at what rate. The MPFS outlines the payment rates for services covered under Medicare Part B, and it is updated annually to reflect changes in policy and practice.
To ascertain if CPT code 92565 is reimbursed, healthcare providers should consult the MPFS to verify its inclusion and the corresponding reimbursement rate. Additionally, Medicare Administrative Contractors (MACs) play a pivotal role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make local coverage determinations (LCDs) that can affect whether a particular service is covered in their jurisdiction.
Therefore, while CPT code 92565 may be listed in the MPFS, providers should also check with their specific MAC to ensure there are no local coverage restrictions or additional documentation requirements that could impact reimbursement. It is advisable for healthcare providers to stay informed about any updates to the MPFS and MAC guidelines to ensure compliance and optimize reimbursement for services rendered.
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 the Stenger test pure tone (CPT code 92565), ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can optimize your revenue recovery process.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
