Local Coverage Article Billing and Coding

Billing and Coding: Vestibular Function Testing

A56497

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Article Information

General Information

Article ID
A56497
Article Title
Billing and Coding: Vestibular Function Testing
Article Type
Billing and Coding
Original Effective Date
04/18/2019
Revision Effective Date
01/01/2021
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim that lacks the necessary information to process that claim.

CMS Internet-Only Manual, Pub 100-08, Medicare Program Integrity Manual, Chapter 3, §3.4.1.3 Diagnosis Code Requirements

 

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Vestibular Function Testing L34537.

Appropriate ICD-10-CM codes must be submitted with each claim. Claims submitted without such evidence will be denied as not medically necessary.

It is not enough to link the procedure code to a payable ICD-10-CM code. The diagnosis or clinical suspicion must be present for the procedure to be paid, and the patient's medical record must document that the coverage criteria in this policy have been met. Covered services must meet general community standards of appropriate medical care. For example, extremely mild symptoms of very short duration may not justify procedures or testing, even though a listed ICD-10-CM symptom might superficially be met. Inclusion of certain "not otherwise specified" codes does not mean that any other associated disorder is covered.

Repeat testing on a regular basis, in the absence of the resumption of symptoms, is not warranted. A few conditions may require testing on multiple days due to variably acute symptoms, such as benign positional vertigo, which varies with inner ear canal stones. However, in this case, isolated testing with CPT® 92542 is usually sufficient, and within several episodes, a diagnosis should be established.

CPT® codes 92541 and 92542 are more likely to be medically necessary for follow up of disorders, likely secondary to canal block pathology. For this purpose, there may be testing at several visits, at intervals, for evaluation of interval change and symptoms.

Scope of Practice

Diagnostic procedures 92541-92542 and 92544-92548 may be performed only by licensed audiologists with a physician’s order; by a licensed physician, preferably with certification by the American Board of Medical Specialties in Otolaryngology, Neurology or Otology/Neurology; or other providers licensed to practice medicine under the personal supervision of an appropriate physician as described in the Code of Federal Register (CFR).

Basic Audiometry

CPT® code 92552 or 92553 will be covered if ordered and performed in conjunction with VFT. CPT® code 92557 will also be covered if ordered and performed in conjunction with Vestibular Function Testing (VFT), instead of CPT® code 92553, when the speech recognition component of the CPT® code 92557 is reasonable and necessary in the diagnosis or treatment of an individual Medicare beneficiary (e.g., Vestibular Schwannoma). No other hearing tests will be covered, when performed in conjunction with VFT for the diagnosis of balance problems.

CPT® code 92557 - This is a comprehensive audiometry evaluation, which includes a battery of tests comprised both of the elements of threshold evaluation (hearing threshold levels at various frequencies presented by both air and bone conduction) and speech audiometry, including both speech reception and speech recognition testing. CPT® code 92557 includes the elements of CPT® codes 92553 and 92556; therefore, these codes cannot be billed on the same date of service in addition to CPT® code 92557.

Summary

CPT® codes 92542, 92544, 92545, 92546, and 92548 are billable once per day, and repeated analysis or confirmation of findings within the session is considered part of 1 test. Note, for example, that CPT® code 92542 specifically requires 4 or more positions tested in order to bill for 1 unit (per CPT® definition).

CPT® code 92537 is intended to report a complete caloric vestibular testing procedure that includes bilateral performance of bithermal irrigation (i.e., one warm and one cool irrigation for each ear). Fewer irrigation procedures require a different method of reporting according to what was done. For 3 irrigations (e.g., irrigation of both ears using monothermal irrigation of 1 ear and bithermal irrigation of the contralateral ear), code 92537 and report with modifier 52. Monothermal irrigation (i.e., irrigation of both ears with either cool or warm irrigation) is reported once with CPT® code 92538. If a single ear is irrigated with a single method of irrigation (cool or warm) code 92538 is reported once with modifier 52, as described in the CPT® Insiders View January 2016.

CPT® code 92547 may be billed multiple times as required by other medically necessary tests. Since the same electrodes are typically used for several serial tests, billing more than 6 per day would be atypical.

CPT® codes 92531, 92532, 92533, and 92534 for vestibular function tests, without electrical recording are considered bundled physical examination codes by Centers for Medicare and Medicaid Services (CMS), have Relative Value Units (RVU’s) of zero, and are not payable.

Coding Information

CPT/HCPCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
92517 VESTIBULAR EVOKED MYOGENIC POTENTIAL (VEMP) TESTING, WITH INTERPRETATION AND REPORT; CERVICAL (CVEMP)
92518 VESTIBULAR EVOKED MYOGENIC POTENTIAL (VEMP) TESTING, WITH INTERPRETATION AND REPORT; OCULAR (OVEMP)
92519 VESTIBULAR EVOKED MYOGENIC POTENTIAL (VEMP) TESTING, WITH INTERPRETATION AND REPORT; CERVICAL (CVEMP) AND OCULAR (OVEMP)
92537 CALORIC VESTIBULAR TEST WITH RECORDING, BILATERAL; BITHERMAL (IE, ONE WARM AND ONE COOL IRRIGATION IN EACH EAR FOR A TOTAL OF FOUR IRRIGATIONS)
92538 CALORIC VESTIBULAR TEST WITH RECORDING, BILATERAL; MONOTHERMAL (IE, ONE IRRIGATION IN 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 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
92547 USE OF VERTICAL ELECTRODES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
92548 COMPUTERIZED DYNAMIC POSTUROGRAPHY SENSORY ORGANIZATION TEST (CDP-SOT), 6 CONDITIONS (IE, EYES OPEN, EYES CLOSED, VISUAL SWAY, PLATFORM SWAY, EYES CLOSED PLATFORM SWAY, PLATFORM AND VISUAL SWAY), INCLUDING INTERPRETATION AND REPORT;
92549 COMPUTERIZED DYNAMIC POSTUROGRAPHY SENSORY ORGANIZATION TEST (CDP-SOT), 6 CONDITIONS (IE, EYES OPEN, EYES CLOSED, VISUAL SWAY, PLATFORM SWAY, EYES CLOSED PLATFORM SWAY, PLATFORM AND VISUAL SWAY), INCLUDING INTERPRETATION AND REPORT; WITH MOTOR CONTROL TEST (MCT) AND ADAPTATION TEST (ADT)
92552 PURE TONE AUDIOMETRY (THRESHOLD); AIR ONLY
92553 PURE TONE AUDIOMETRY (THRESHOLD); AIR AND BONE
92556 SPEECH AUDIOMETRY THRESHOLD; WITH SPEECH RECOGNITION
92557 COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION AND SPEECH RECOGNITION (92553 AND 92556 COMBINED)

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
52 REDUCED SERVICES: UNDER CERTAIN CIRCUMSTANCES A SERVICE OR PROCEDURE IS PARTIALLY REDUCED OR ELIMINATED AT THE PHYSICIAN'S DISCRETION. UNDER THESE CIRCUMSTANCES THE SERVICE PROVIDED CAN BE IDENTIFIED BY ITS USUAL PROCEDURE NUMBER AND THE ADDITION OF THE MODIFIER -52, SIGNIFYING THAT THE SERVICE IS REDUCED. THIS PROVIDES A MEANS OF REPORTING REDUCED SERVICES WITHOUT DISTURBING THE IDENTIFICATION OF THE BASIC SERVICE. MODIFIER CODE 09952 MAY BE USED AS AN ALTERNATIVE TO MODIFIER -52. NOTE: FOR HOSPITAL OUTPATIENT REPORTING OF A PREVIOUSLY SCHEDULED PROCEDURE/SERVICE THAT IS PARTIALLY REDUCED OR CANCELLED AS A RESULT OF EXTENUATING CIRCUMSTANCES OR THOSE THAT THREATEN THE WELL-BEING OF THE PATIENT PRIOR TO OR AFTER ADMINISTRATION OF ANESTHESIA, SEE MODIFIERS -73 AND -74 (SEE MODIFIERS APPROVED FOR ASC HOSPITAL OUTPATIENT USE).

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
D33.3 Benign neoplasm of cranial nerves
H81.01 Meniere's disease, right ear
H81.02 Meniere's disease, left ear
H81.03 Meniere's disease, bilateral
H81.11 Benign paroxysmal vertigo, right ear
H81.12 Benign paroxysmal vertigo, left ear
H81.13 Benign paroxysmal vertigo, bilateral
H81.21 Vestibular neuronitis, right ear
H81.22 Vestibular neuronitis, left ear
H81.23 Vestibular neuronitis, bilateral
H81.311 Aural vertigo, right ear
H81.312 Aural vertigo, left ear
H81.313 Aural vertigo, bilateral
H81.391 Other peripheral vertigo, right ear
H81.392 Other peripheral vertigo, left ear
H81.393 Other peripheral vertigo, bilateral
H81.4 Vertigo of central origin
H81.8X1 Other disorders of vestibular function, right ear
H81.8X2 Other disorders of vestibular function, left ear
H81.8X3 Other disorders of vestibular function, bilateral
H81.91 Unspecified disorder of vestibular function, right ear
H81.92 Unspecified disorder of vestibular function, left ear
H81.93 Unspecified disorder of vestibular function, bilateral
H82.1 Vertiginous syndromes in diseases classified elsewhere, right ear
H82.2 Vertiginous syndromes in diseases classified elsewhere, left ear
H82.3 Vertiginous syndromes in diseases classified elsewhere, bilateral
H83.01 Labyrinthitis, right ear
H83.02 Labyrinthitis, left ear
H83.03 Labyrinthitis, bilateral
H83.11 Labyrinthine fistula, right ear
H83.12 Labyrinthine fistula, left ear
H83.13 Labyrinthine fistula, bilateral
H83.2X1 Labyrinthine dysfunction, right ear
H83.2X2 Labyrinthine dysfunction, left ear
H83.2X3 Labyrinthine dysfunction, bilateral
H83.8X1 Other specified diseases of right inner ear
H83.8X2 Other specified diseases of left inner ear
H83.8X3 Other specified diseases of inner ear, bilateral
H83.91 Unspecified disease of right inner ear
H83.92 Unspecified disease of left inner ear
H83.93 Unspecified disease of inner ear, bilateral
H90.0 Conductive hearing loss, bilateral
H90.11 Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
H90.12 Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
H90.3* Sensorineural hearing loss, bilateral
H90.41* Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
H90.42* Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
H90.6 Mixed conductive and sensorineural hearing loss, bilateral
H90.71 Mixed conductive and sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
H90.72 Mixed conductive and sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
H90.A11 Conductive hearing loss, unilateral, right ear with restricted hearing on the contralateral side
H90.A12 Conductive hearing loss, unilateral, left ear with restricted hearing on the contralateral side
H90.A21* Sensorineural hearing loss, unilateral, right ear, with restricted hearing on the contralateral side
H90.A22* Sensorineural hearing loss, unilateral, left ear, with restricted hearing on the contralateral side
H90.A31* Mixed conductive and sensorineural hearing loss, unilateral, right ear with restricted hearing on the contralateral side
H90.A32* Mixed conductive and sensorineural hearing loss, unilateral, left ear with restricted hearing on the contralateral side
R42 Dizziness and giddiness
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

Tests for the ICD-10 diagnosis codes indicated with an asterisk (*) are covered only for an initial evaluation of a balance problem: H90.3*, H90.41*, H90.42*, H90.A21*, H90.A22*, H90.A31*, H90.A32*.

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/01/2021 R7

Under CPT/HCPCS Codes Group 1 Codes: added codes 92517, 92518, and 92519. This revision is due to the Q1 2021 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/2021.

05/28/2020 R6

Under Article Text: Basic Audiometry added verbiage “CPT® code 92557 will also be covered if ordered and performed in conjunction with VFT, instead of CPT® code 92553, when the speech recognition component of the CPT® code 92557 is reasonable and necessary in the diagnosis or treatment of an individual Medicare beneficiary (e.g., Vestibular Schwannoma)”. Under ICD-10 Codes that Support Medical Necessity Group 1: Codes add ICD-10 code D33.3. Formatting, punctuation and typographical errors were corrected throughout the Article.

01/01/2020 R5

Under CPT/HCPCS Codes Group 1: Codes added CPT® code 92549. The code description was revised for CPT® code 92548. This revision is due to the Annual CPT®/HCPCS Code Update and becomes effective on 1/1/2020.

10/17/2019 R4

This article is being revised in order to adhere to CMS requirements per Chapter 13, Section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Vestibular Function Testing L34537 LCD and placed in this article. Under CPT/HCPCS modifiers section added modifier 52. Under ICD-10 Codes that Support Medical Necessity Group 1: Paragraph removed verbiage and added verbiage to ICD-10 Codes that Support Medical Necessity Group 1: Medical Necessity ICD-10 Codes Asterisk Explanation.

10/01/2019 R3

Under Covered ICD-10 Codes Group 1: Codes ICD-10 codes H81.41, H81.42, and H81.43 were deleted. ICD-10 code H81.4 was added. This revision is due to the 2019 Annual ICD-10 Code Update and will become effective on October 1, 2019.

05/16/2019 R2

Under Article Text added the subheading Scope of Practice and the corresponding verbiage “Diagnostic procedures 92541-92542 and 92544-92548 may be performed only by licensed audiologists with a physician’s order; by a licensed physician, preferably with certification by the American Board of Medical Specialties in Otolaryngology, Neurology or Otology/Neurology; or other providers licensed to practice medicine under the personal supervision of an appropriate physician as described in the Code of Federal Register (CFR).” Added subheading Basic Audiometry and the corresponding verbiage “CPT® code 92552 or 92553 will be covered by this A/B MAC if ordered and performed in conjunction with Vestibular Function Testing (VFT). No other hearing tests will be covered by this A/B MAC when performed in conjunction with VFT, for the diagnosis of balance problems. CPT® code 92557 - This is a comprehensive audiometry evaluation which includes a battery of tests comprised both of the elements of threshold evaluation (hearing threshold levels at various frequencies presented by both air and bone conduction) and speech audiometry including both speech reception and speech recognition testing. CPT® code 92557 includes the elements of CPT® codes 92553 and 92556, therefore, these codes cannot be billed on the same date of service in addition to CPT® code 92557.”

05/10/2019 R1

All coding located in the Coding Information section has been removed from the related Vestibular Function Testing L34537 LCD and added to this article. Under Covered ICD-10 Codes Group 1: Codes added H90.6.

Associated Documents

Related Local Coverage Documents
LCDs
L34537 - Vestibular Function Testing
Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
02/09/2021 01/01/2021 - N/A Currently in Effect You are here
04/27/2020 05/28/2020 - 12/31/2020 Superseded View
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Keywords

  • Vestibular