CPT CODES

CPT Code 92626

CPT code 92626 is used for evaluating auditory function for the first hour, helping healthcare providers document and manage auditory assessments.

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What is CPT Code 92626

CPT code 92626 is used to describe the evaluation of auditory function for the first hour. This code is typically utilized by audiologists or other healthcare professionals to assess a patient's hearing capabilities and auditory processing. The evaluation may include a variety of tests and assessments to determine the extent of hearing loss or auditory dysfunction, and it is crucial for developing an appropriate treatment plan or intervention strategy. This code specifically accounts for the initial hour of evaluation, and additional time may be billed using a different code if the assessment extends beyond this period.

Does CPT 92626 Need a Modifier?

For CPT code 92626, which pertains to the evaluation of auditory function for the first hour, the following modifiers may be applicable:

1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required. If the evaluation of auditory function is more complex or time-consuming than usual, this modifier may be appropriate.

2. Modifier 52 (Reduced Services): If the service provided was less extensive than described in the CPT code, such as if the evaluation was not completed or was terminated early, this modifier can be used to indicate that the service was reduced.

3. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): This modifier is applicable if the same procedure is repeated on the same day by the same provider. If multiple evaluations are necessary within the same day, this modifier should be used.

4. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): If the procedure is repeated on the same day by a different provider, this modifier is appropriate.

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 may be necessary if the evaluation is performed in conjunction with other procedures that are not typically performed together.

6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although primarily used for laboratory tests, this modifier can be applicable if the evaluation is repeated for clinical reasons, such as verifying results or assessing changes in auditory function.

7. Modifier 95 (Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System): If the evaluation is conducted via telemedicine, this modifier should be used to indicate the service was provided through a telehealth platform.

These modifiers help provide additional context and specificity to the billing process, ensuring accurate representation of the services rendered. Always consult the latest coding guidelines and payer-specific policies to confirm the appropriate use of modifiers.

CPT Code 92626 Medicare Reimbursement

CPT code 92626 is reimbursed by Medicare, but its reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered under Medicare Part B, and CPT code 92626 is included in this schedule. However, the actual reimbursement can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to interpret national policies and establish local coverage determinations, which can affect whether and how a particular service is reimbursed. Therefore, healthcare providers should consult their specific MAC for detailed information on the reimbursement criteria and rates for CPT code 92626.

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