CPT code 92573 is used for the Lombard test, an audiological procedure to assess hearing by measuring involuntary vocal changes.
CPT code 92573 is used to describe the Lombard test, which is an audiological procedure. This test is designed to assess the presence of non-organic hearing loss, also known as functional hearing loss, where there is no identifiable physiological cause for the hearing impairment. During the Lombard test, the patient is asked to read or speak while background noise is gradually increased. If the patient involuntarily raises their voice to compensate for the noise, it suggests that their hearing loss may not be genuine. This code is utilized by audiologists and other healthcare providers to document and bill for this specific diagnostic service.
For CPT code 92573, which pertains to the Lombard test, the following modifiers may be applicable depending on the specific circumstances of the service provided:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide a service is substantially greater than typically required. It may be applicable if the Lombard test involves additional complexity or time.
2. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. It may apply if the Lombard test is not completed in its entirety.
3. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same provider. It may be relevant if the Lombard test needs to be conducted more than once on the same day.
4. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by a different provider. It may apply if the Lombard test is repeated by another healthcare professional.
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 may be used if the Lombard test is performed in conjunction with other audiological tests but is distinct in its purpose.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used for repeat laboratory tests performed on the same day to obtain subsequent (multiple) test results. It may be applicable if the Lombard test is repeated for diagnostic purposes.
These modifiers should be used in accordance with payer policies and documentation requirements to ensure accurate billing and reimbursement.
The CPT code 92573 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies of the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates. However, the final decision on reimbursement can vary based on local coverage determinations (LCDs) made by the MACs, which are responsible for processing Medicare claims and ensuring compliance with Medicare policies.
Therefore, it is crucial for healthcare providers to verify the specific guidelines and reimbursement rates for CPT code 92573 with their regional MAC to ensure accurate billing and optimal reimbursement.
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