CPT CODES

CPT Code 92590

CPT code 92590 is for a hearing aid exam for one ear, used by healthcare providers to standardize and document medical procedures.

Table of Contents
What is CPT Code 92590
Does CPT 92590 Need a Modifier?
CPT Code 92590 Medicare Reimbursement
Are You Being Underpaid for 92590 CPT Code?
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What is CPT Code 92590

CPT code 92590 is used to describe a hearing aid examination and selection for one ear. This code is typically utilized by audiologists or hearing specialists when they conduct a comprehensive evaluation to determine the most suitable hearing aid for a patient's specific hearing needs in one ear. The process involves assessing the patient's hearing loss, discussing hearing aid options, and selecting the appropriate device that will provide the best auditory assistance. This code is essential for billing purposes, ensuring that healthcare providers are reimbursed for their professional services related to hearing aid evaluation and selection.

Does CPT 92590 Need a Modifier?

For CPT code 92590, which pertains to a hearing aid examination for one ear, the following modifiers may be applicable:

1. Modifier -22 (Increased Procedural Services): This modifier is used when the work required to perform the service is substantially greater than typically required. It may be applicable if the examination involves additional complexity or time due to patient-specific factors.

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 might be applicable if the examination was not completed in full due to patient cooperation or other factors.

3. Modifier -76 (Repeat Procedure by Same Physician): This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure. It could be relevant if the hearing aid exam needs to be repeated within a short timeframe.

4. Modifier -77 (Repeat Procedure by Another Physician): This modifier is used when a procedure or service is repeated by another physician or qualified healthcare professional. It may be applicable if the patient seeks a second opinion or requires a follow-up exam by a different provider.

5. Modifier -78 (Unplanned Return to the Operating/Procedure Room): Although less common for this type of service, this modifier is used for an unplanned return to the procedure room for a related procedure during the postoperative period. It might be relevant if complications arise necessitating a return visit.

6. Modifier -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period. It could apply if the patient requires an unrelated hearing aid exam during the postoperative period of another procedure.

7. Modifier -95 (Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System): This modifier is used when the hearing aid exam is conducted via telemedicine, allowing for remote evaluation.

These modifiers help provide additional context and detail about the service rendered, ensuring accurate billing and reimbursement. It is important to use them appropriately based on the specific circumstances of the service provided.

CPT Code 92590 Medicare Reimbursement

CPT code 92590, which pertains to a hearing aid exam for one ear, is generally not reimbursed by Medicare. This is because Medicare typically does not cover routine hearing exams or hearing aids. However, it's important to verify this information with the Medicare Physician Fee Schedule (MPFS) and consult with your local Medicare Administrative Contractor (MAC) for any specific regional policies or exceptions that might apply.

The MACs are responsible for processing Medicare claims and can provide guidance on coverage determinations and reimbursement specifics for your area.

Are You Being Underpaid for 92590 CPT Code?

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