CPT code 92651 is used for determining auditory evoked potential hearing status, including interpretation and report.
CPT code 92651 is used to describe the procedure for determining auditory evoked potentials (AEP) to assess hearing status, specifically through initial and repeat testing. This code is typically utilized by audiologists or other healthcare professionals to evaluate the auditory system's response to sound stimuli. The procedure involves measuring the electrical activity in the brain in response to sound, which helps in diagnosing hearing loss or other auditory disorders. This code is crucial for billing purposes, ensuring that healthcare providers are accurately reimbursed for the specialized testing they perform.
For CPT code 92651, which involves auditory evoked potentials (AEP) for determining hearing status, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier can be used if the procedure required significantly more work than typically required. This could be due to patient-specific factors or complexities during the procedure.
2. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the discretion of the healthcare provider, this modifier may be applied to indicate that the service was not performed in its entirety.
3. Modifier 76 - Repeat Procedure by Same Physician or Other Qualified Health Care Professional: If the same procedure is repeated on the same day by the same provider, this modifier is used to indicate the repetition.
4. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the procedure is repeated on the same day by a different provider.
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 is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: If the test is repeated for clinical reasons on the same day, this modifier is used to indicate the necessity of the repeat test.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 92651 is related to auditory evoked potentials and is used to determine hearing status. Whether this code is reimbursed by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the specific Medicare Administrative Contractor (MAC) that processes claims in your region.
To determine if CPT code 92651 is reimbursed by Medicare, healthcare providers should first consult the MPFS, which lists the payment rates for services covered under Medicare Part B. If the code is listed in the MPFS, it indicates that Medicare has established a reimbursement rate for it, subject to meeting medical necessity and documentation requirements.
Additionally, providers should review the Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) issued by their MAC. These documents provide guidance on the conditions under which Medicare will cover specific services, including any limitations or documentation requirements that must be met for reimbursement.
In summary, while CPT code 92651 may be included in the MPFS, its reimbursement by Medicare is contingent upon adherence to the coverage criteria set forth by the relevant MAC. Healthcare providers should ensure compliance with these guidelines to facilitate successful reimbursement.
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