CPT for ENT: Vestibular testing, Auditory Brainstem Response (ABR), and Otoacoustic Emissions

Q: What code(s) should physicians report for the interpretation component of auditory brainstem response (ABR), vestibular testing, and Otoacoustic Emissions (OAE) services?

A: The following CPT codes for ABR, vestibular testing, and OAE services have separately defined technical (TC) and professional (26) components according to the AMA’s Current Procedural Terminology.

• 92537 Caloric vestibular test, with recording, bilateral; bithermal (i.e., One warm and one cool for each ear for a total of four irrigations)
• 92538 monothermal (i.e., One irrigation for each ear for a total of two irrigations)
• 92540 Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording
• 92541 Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording
• 92542 Positional nystagmus test, minimum of four (4) positions, with recording
• 92544 Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording
• 92545 Oscillating tracking test, with recording
• 92546 Sinusoidal vertical axis rotational testing
• 92548 Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions (i.e., Eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report
• 92549   with motor control test (MCT) and adaptation test (ADT)
• 92650 Auditory evoked potentials; screening of auditory potential with broadband stimuli, automated analysis (This is intended for automated screening eg in newborns)
• 92651 for hearing status determination, broadband stimuli, with interpretation and report (this is a non-automated confirmatory test to determine if a hearing loss is present)
• 92652 for threshold estimation at multiple frequencies, with interpretation and report (This is a frequency-specific threshold test to allow fitting of amplification)
• 92653 neurodiagnostic, with interpretation and report (This is an auditory brainstem response test to evaluate waveforms)
• 92558 Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis
• 92587 Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report
• 92588 comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlea mapping, minimum of 12 frequencies), with interpretation and report
• 92517 Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP)
• 92518 ocular (oVEMP)
• 92519 cervical (cVEMP) and ocular (oVEMP)

You can report the professional component of the ABR using modifier 26. The audiologist (if he or she is employed by the facility) or the facility would bill the technical component using the TC modifier.

Please refer to the CPT guide as several of the neurodiagnostic codes contain parentheticals that preclude reporting many of the above codes together as the more complex codes include the work of the simpler base codes.

Note: If the physician or physician group owns the audiometric equipment in the office, he or she should not append any modifiers to the CPT codes. In this case, the physician or physician group is entitled to reimbursement of both the professional and technical components.

Revised October 2023

IMPORTANT DISCLAIMER NOTICE

CPT FOR ENT ARTICLES ARE A COLLABORATIVE EFFORT BETWEEN THE ACADEMY’S TEAM OF CPT ADVISORS, MEMBERS OF THE PHYSICIAN PAYMENT POLICY (3P) WORKGROUP, AND HEALTH POLICY STAFF. ARTICLES ARE DEVELOPED TO ADDRESS COMMON CODING QUESTIONS RECEIVED BY THE HEALTH POLICY TEAM, AS WELL AS TO CLARIFY CODING CHANGES AND CORRECT CODING PRINCIPLES FOR FREQUENTLY REPORTED ENT PROCEDURES. THESE ARTICLES ARE NOT INTENDED AS LEGAL, MEDICAL, OR BUSINESS ADVICE AND ARE NOT A GUARANTEE OF REIMBURSEMENT. THE INFORMATION IS ALSO NOT MEANT TO SERVE AS THE DEFINITIVE OR SOLE AUTHORITY ON BILLING AND CODING ISSUES. THE APPLICABILITY OF AAO-HNS BILLING AND CODING GUIDANCE FOR A PARTICULAR PROCEDURE, MUST BE DETERMINED BY THE RESPONSIBLE PHYSICIAN IN LIGHT OF ALL THE CIRCUMSTANCES PRESENTED BY THE INDIVIDUAL PATIENT. YOU SHOULD CONSULT WITH YOUR OWN ADVISORS AS WELL AS MEDICARE OR PRIVATE CARRIERS IN MAKING ANY DECISIONS ABOUT HOW TO BILL AND CODE PARTICULAR SERVICES OR PROCEDURES.