CPT code 92586 is used for auditory evoked potential testing, which measures the brain's response to sounds to assess hearing function.
CPT code 92586 is used to describe the procedure for auditory evoked potentials for limited evaluation. This code is typically utilized in the context of assessing the auditory nerve pathways and brainstem function in response to sound stimuli. The "limited" aspect of this code indicates that the evaluation is not as comprehensive as other auditory evoked potential tests, focusing on specific aspects or a reduced scope of the auditory pathway. This procedure is often employed in clinical settings to help diagnose hearing impairments or neurological disorders related to auditory processing.
For CPT code 92586, which involves auditory evoked potentials, 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 a procedure or service was distinct or independent from other services performed on the same day. It may be necessary if multiple auditory tests are performed and need to be billed separately.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day. It is applicable if the auditory evoked potential test needs to be repeated for clinical reasons.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician on the same day. It applies if the test is repeated by another healthcare provider.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used when a laboratory test is repeated on the same day to obtain subsequent results. It may be applicable if the auditory evoked potential test is repeated for confirmation or additional data.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the service provided. It's important to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 92586 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the specific Medicare Administrative Contractor (MAC) overseeing the region where the service is provided.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers on a fee-for-service basis. Each MAC may have specific guidelines and coverage determinations that affect whether CPT code 92586 is reimbursed.
Providers should consult the MPFS for the current year and check with their local MAC to determine if CPT code 92586 is covered and reimbursed by Medicare in their area.
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