CPT code 92571 is used for a filtered speech hearing test, a procedure to assess hearing ability by filtering specific speech frequencies.
CPT code 92571 is used to describe a filtered speech hearing test. This test is designed to assess an individual's ability to understand speech when certain frequencies are filtered out, simulating real-world listening conditions where background noise or hearing loss might affect speech comprehension. It helps audiologists determine the specific challenges a patient may face in everyday communication and tailor treatment or hearing aid solutions accordingly.
For the CPT code 92571, "Filtered speech 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 service provided was significantly more complex or required more time than usual. Documentation must support the increased effort.
2. Modifier 52 - Reduced Services: This modifier is appropriate if the procedure was partially reduced or eliminated at the physician's discretion. Documentation should reflect the reason for the reduction.
3. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Apply this modifier if the same procedure is repeated on the same day by the same provider.
4. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Use this modifier if the procedure is repeated on the same day by a different provider.
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 often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for laboratory tests, this modifier can be applicable if the hearing test needs to be repeated for clinical reasons on the same day.
7. Modifier 95 - Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System: Use this modifier if the hearing test is conducted via telemedicine, ensuring compliance with telehealth service billing.
Each modifier should be used in accordance with payer guidelines and supported by appropriate documentation to justify its application.
CPT code 92571, which is associated with a filtered speech hearing test, is subject to reimbursement by Medicare, but this depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines 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 reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a significant 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 92571 may be listed on the MPFS, its reimbursement can vary based on the specific policies and guidelines set forth by the MACs in different regions.
Healthcare providers should consult the latest MPFS and check with their respective MAC to confirm the reimbursement status of CPT code 92571, ensuring compliance with any local coverage determinations or specific billing requirements.
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