CPT code 92591 is used for a hearing aid examination for both ears, helping healthcare providers document and manage auditory assessments.
CPT code 92591 is used to describe a comprehensive examination and evaluation of hearing aids for both ears. This code is typically utilized by audiologists or hearing specialists when they conduct a thorough assessment of a patient's hearing aids to ensure they are functioning correctly and are appropriately fitted for the patient's needs. The evaluation may include testing the performance of the hearing aids, making necessary adjustments, and providing guidance on their use and maintenance. This service is crucial for optimizing the hearing aid's effectiveness and ensuring the patient's auditory health is well-managed.
For CPT code 92591, which pertains to a hearing aid examination for both ears, the following modifiers may be applicable:
1. Modifier -22 (Increased Procedural Services): This modifier is used when the work required to provide the service is substantially greater than typically required. This could apply if the examination involves additional complexities or time due to patient-specific factors.
2. Modifier -52 (Reduced Services): This modifier is applicable if the service provided is partially reduced or eliminated at the discretion of the healthcare provider. For instance, if the examination was only partially completed due to patient non-compliance or other factors.
3. Modifier -76 (Repeat Procedure by Same Physician): This modifier is used if the same procedure is repeated by the same provider on the same day. It might be relevant if the initial examination was inconclusive and needed to be repeated.
4. Modifier -77 (Repeat Procedure by Another Physician): This is used when the procedure is repeated by a different provider on the same day. It could be relevant if a second opinion or additional expertise was required.
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 might be necessary if the hearing aid exam is performed in conjunction with other unrelated procedures.
6. Modifier -GA (Waiver of Liability Statement Issued as Required by Payer Policy): This modifier is used when a provider expects that Medicare will deny a service as not reasonable and necessary, and an Advance Beneficiary Notice (ABN) has been issued.
7. Modifier -GX (Notice of Liability Issued, Voluntary Under Payer Policy): This is used when a voluntary ABN was issued for a service that is not covered.
8. Modifier -GY (Item or Service Statutorily Excluded or Does Not Meet the Definition of Any Medicare Benefit): This modifier is used when the service is not covered by Medicare.
9. Modifier -GZ (Item or Service Expected to Be Denied as Not Reasonable and Necessary): This is used when an ABN was not issued, but the provider expects denial.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the service provided. Always verify payer-specific guidelines, as modifier usage can vary.
CPT code 92591, which pertains to a hearing aid exam for both ears, is reimbursed by Medicare under specific circumstances. To determine if this code is reimbursed, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare. Additionally, reimbursement can vary based on the policies of the local Medicare Administrative Contractor (MAC), which administers Medicare claims for specific regions. Providers should verify with their MAC to ensure compliance with local coverage determinations and any specific documentation requirements that may affect reimbursement for CPT code 92591.
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 and by individual payer. For instance, with CPT code 92591, RevFind ensures you capture every dollar owed for hearing aid exams for both ears. Schedule a demo today to see how RevFind can help you identify and recover underpayments effectively.
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
