CPT code 92625 is used for procedures related to evaluating tinnitus, a condition characterized by ringing or noise perception in the ears.
CPT code 92625 is used for a tinnitus assessment. This code represents a comprehensive evaluation process conducted by healthcare professionals to assess the presence and severity of tinnitus in a patient. Tinnitus is the perception of noise or ringing in the ears, and this assessment involves various tests and procedures to determine the underlying causes and impact on the patient's quality of life. The evaluation may include audiological tests, questionnaires, and other diagnostic measures to develop an appropriate management or treatment plan for the patient.
For CPT code 92625, which pertains to tinnitus assessment, 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. For instance, if the tinnitus assessment is unusually complex or time-consuming, this modifier may be appropriate.
2. Modifier 52 - Reduced Services: If the tinnitus assessment is partially completed or less comprehensive than usual, this modifier indicates that the service was reduced at the provider's discretion.
3. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used if the tinnitus assessment needs to be repeated on the same day by the same provider due to clinical necessity.
4. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: If the assessment is repeated on the same day by a different provider, this modifier is applicable.
5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the tinnitus assessment is distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits when services are typically bundled.
6. Modifier 95 - Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System: If the tinnitus assessment is conducted via telemedicine, this modifier is used to indicate that the service was provided through a real-time interactive audio and video system.
7. Modifier GT - Via Interactive Audio and Video Telecommunications Systems: Similar to Modifier 95, this is used for telehealth services, indicating that the tinnitus assessment was conducted via interactive audio and video telecommunications.
These modifiers should be used appropriately based on the specific circumstances of the service provided, ensuring accurate billing and compliance with payer requirements.
The CPT code 92625, which is used for tinnitus assessment, is subject to reimbursement by Medicare, but this depends on several factors. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of services covered by Medicare, including their reimbursement rates. To determine if CPT code 92625 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the specific reimbursement rate applicable to their geographic location.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can have local coverage determinations (LCDs) that affect whether a particular service is reimbursed. Providers should check with their specific MAC to see if there are any local policies or requirements that impact the reimbursement of CPT code 92625. This ensures compliance with both national and regional Medicare guidelines, facilitating accurate and timely 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 and by individual payer. For instance, with RevFind, you can identify discrepancies related to CPT code 92625. Schedule a demo today to see how our solution can help you maximize your reimbursements and ensure you're getting paid what you deserve.
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
