CPT code 92582 is used for conditioning play audiometry, a hearing test method for children using play activities to gauge auditory response.
CPT code 92582 is used to describe conditioning play audiometry, a hearing test method typically employed for young children or individuals who may have difficulty with standard audiometry tests. This procedure involves using play-based activities to engage the patient and encourage them to respond to auditory stimuli. The goal is to assess the patient's hearing ability by observing their responses to various sounds, which are presented through headphones or speakers. This code is essential for billing purposes, ensuring that healthcare providers are reimbursed for the specialized service of evaluating hearing in a manner that is suitable for the patient's developmental level.
For CPT code 92582, "Conditioning play audiometry," 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 required significantly greater effort than typically required. Documentation must support the substantial additional work.
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 indicates that the full service was not performed.
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 when the same 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 typically used for lab tests, if the audiometry test is repeated for a valid medical reason, this modifier may be applicable.
7. Modifier 95 - Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System: If the audiometry service is provided via telemedicine, this modifier indicates that the service was rendered through a real-time interactive audio and video system.
These modifiers should be used in accordance with payer policies and specific clinical scenarios. Proper documentation is essential to justify the use of any modifier.
CPT code 92582, which refers to conditioning play audiometry, is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines. The Medicare Physician Fee Schedule (MPFS) provides the framework for determining the reimbursement rates for this service. The MPFS outlines the payment amounts for services covered under Medicare Part B, including audiometry services.
However, it's important to note that the reimbursement for CPT code 92582 can vary based on geographic location and other factors. Medicare Administrative Contractors (MACs) are responsible for processing claims and have the authority to make determinations on coverage and reimbursement specifics within their respective jurisdictions. Therefore, healthcare providers should consult their local MAC for detailed information on the reimbursement criteria and any potential local coverage determinations (LCDs) that may affect the payment for this service.
Additionally, providers should ensure that all documentation and billing practices align with Medicare's requirements to facilitate proper reimbursement.
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. For instance, with CPT code 92582, RevFind identifies discrepancies with individual payers, ensuring you capture every dollar owed. 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
