Local Coverage Article Billing and Coding

Billing and Coding: Vestibular and Audiologic Function Studies

A57434

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General Information

Article ID
A57434
Article Title
Billing and Coding: Vestibular and Audiologic Function Studies
Article Type
Billing and Coding
Original Effective Date
10/01/2019
Revision Effective Date
10/01/2021
Revision Ending Date
N/A
Retirement Date
N/A
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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

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L35007 (Vestibular and Audiologic Function Studies). Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Consistent with the LCD, CPT codes 92553, 92557 and 92568 may be performed when there is current long-term use of ototoxic antibiotics.

The professional component of the services represented by CPT codes 92537, 92538, 92541, 92542, 92544, 92545, 92546, 92587, 92588, 92651, 92652, and 92653 may be reported for services performed in inpatient, outpatient, nursing facilities (when Part A benefits have been exhausted), rehabilitation facilities, hearing and speech centers, independent clinics, and independent diagnostic testing facilities (IDTF).

CPT codes 92547, 92552, 92553, 92555, 92556, 92561, 92562, 92563, 92564, 92565, 92571, 92572, 92575, 92576, 92577, 92582, 92583, and 92584 are considered technical services only codes and may be reported for services performed in the office setting, clinics, hearing and speech centers, and nursing facilities.

Note: Payment for technical components of Technical Component (TC)/Professional Component (PC) services (when the PC is performed by an appropriate professional) and for technical-only services are allowed to hospitals.

Frequency Limitations

Consistent with the utilization outlined in the related LCD:

  • CPT codes 92553, 92557, 92567 and 92568 may be reported once a month when a beneficiary is receiving ototoxic medications
  • The following may only be reported once during a session (same date of service)
    • CPT codes 92541, 92542, 92544,92545 and 92546
  • CPT code 92542 should not be billed two times for two positions or any multiple increments.
  • Payment may be made for two of the following services per patient per year:
    • CPT codes 92541, 92542, 92544, 92545 and 92546

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

Coding Information

CPT/HCPCS Codes

Group 1

Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

The following CPT/HCPCS codes associated with the services outlined in the related policy will not have diagnosis limitations applied at this time: 92601, 92602, 92603, and 92604.

Group 1 Codes
CodeDescription
92537 Caloric vstblr test w/rec
92538 Caloric vstblr test w/rec
92540 Basic vestibular evaluation
92541 Spontaneous nystagmus test
92542 Positional nystagmus test
92544 Optokinetic nystagmus test
92545 Oscillating tracking test
92546 Sinusoidal rotational test
92547 Supplemental electrical test

Group 2

Group 2 Paragraph

N/A

Group 2 Codes
CodeDescription
92550 Tympanometry & reflex thresh
92552 Pure tone audiometry air
92553 Audiometry air & bone
92555 Speech threshold audiometry
92556 Speech audiometry complete
92557 Comprehensive hearing test
92567 Tympanometry
92568 Acoustic refl threshold tst
92570 Acoustic immitance testing

Group 3

Group 3 Paragraph

N/A

Group 3 Codes
CodeDescription
92561 Bekesy audiometry diagnosis

Group 4

Group 4 Paragraph

N/A

Group 4 Codes
CodeDescription
92562 Loudness balance test
92564 Sisi hearing test

Group 5

Group 5 Paragraph

N/A

Group 5 Codes
CodeDescription
92563 Tone decay hearing test

Group 6

Group 6 Paragraph

N/A

Group 6 Codes
CodeDescription
92565 Stenger test pure tone
92577 Stenger test speech

Group 7

Group 7 Paragraph

N/A

Group 7 Codes
CodeDescription
92571 Filtered speech hearing test
92572 Staggered spondaic word test
92576 Synthetic sentence test
92620 Auditory function 60 min
92621 Auditory function + 15 min

Group 8

Group 8 Paragraph

N/A

Group 8 Codes
CodeDescription
92575 Sensorineural acuity test

Group 9

Group 9 Paragraph

N/A

Group 9 Codes
CodeDescription
92582 Conditioning play audiometry
92583 Select picture audiometry

Group 10

Group 10 Paragraph

N/A

Group 10 Codes
CodeDescription
92584 Electrocochleography

Group 11

Group 11 Paragraph

N/A

Group 11 Codes
CodeDescription
92651 Aep hearing status deter i&r
92652 Aep thrshld est mlt freq i&r
92653 Aep neurodiagnostic i&r

Group 12

Group 12 Paragraph

N/A

Group 12 Codes
CodeDescription
92579 Visual audiometry (vra)
92587 Evoked auditory test limited
92588 Evoked auditory tst complete

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claims(s) submitted

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes 92537, 92538, 92540, 92541, 92542, 92544, 92545, 92546 and 92547:

Group 1 Codes
CodeDescription
H81.01 Meniere's disease, right ear
H81.02 Meniere's disease, left ear
H81.03 Meniere's disease, bilateral
H81.09 Meniere's disease, unspecified ear
H81.10 Benign paroxysmal vertigo, unspecified ear
H81.11 Benign paroxysmal vertigo, right ear
H81.12 Benign paroxysmal vertigo, left ear
H81.13 Benign paroxysmal vertigo, bilateral
H81.20 Vestibular neuronitis, unspecified ear
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
H81.319 Aural vertigo, unspecified ear
H81.391 Other peripheral vertigo, right ear
H81.392 Other peripheral vertigo, left ear
H81.393 Other peripheral vertigo, bilateral
H81.399 Other peripheral vertigo, unspecified ear
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
H81.8X9 Other disorders of vestibular function, unspecified ear
H81.90 Unspecified disorder of vestibular function, unspecified ear
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
H83.09 Labyrinthitis, unspecified ear
H83.11 Labyrinthine fistula, right ear
H83.12 Labyrinthine fistula, left ear
H83.13 Labyrinthine fistula, bilateral
H83.19 Labyrinthine fistula, unspecified ear
H83.2X1 Labyrinthine dysfunction, right ear
H83.2X2 Labyrinthine dysfunction, left ear
H83.2X3 Labyrinthine dysfunction, bilateral
H83.2X9 Labyrinthine dysfunction, unspecified ear
H83.90 Unspecified disease of inner ear, unspecified ear
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
H90.2 Conductive hearing loss, unspecified
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
H90.5 Unspecified sensorineural hearing loss
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
H90.8 Mixed conductive and sensorineural hearing loss, unspecified
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
H91.01 Ototoxic hearing loss, right ear
H91.02 Ototoxic hearing loss, left ear
H91.03 Ototoxic hearing loss, bilateral
H91.09 Ototoxic hearing loss, unspecified ear
H91.10 Presbycusis, unspecified ear
H91.11 Presbycusis, right ear
H91.12 Presbycusis, left ear
H91.13 Presbycusis, bilateral
H91.20 Sudden idiopathic hearing loss, unspecified ear
H91.21 Sudden idiopathic hearing loss, right ear
H91.22 Sudden idiopathic hearing loss, left ear
H91.23 Sudden idiopathic hearing loss, bilateral
H91.8X1 - H91.8X9 Other specified hearing loss, right ear - Other specified hearing loss, unspecified ear
H91.90 - H91.93 Unspecified hearing loss, unspecified ear - Unspecified hearing loss, bilateral
R42 Dizziness and giddiness

Group 2

Group 2 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes 92550, 92552, 92553, 92555, 92556, 92557, 92567, 92568 and 92570:

Group 2 Codes
CodeDescription
D33.3 Benign neoplasm of cranial nerves
F44.4 Conversion disorder with motor symptom or deficit
F44.6 Conversion disorder with sensory symptom or deficit
F44.7 Conversion disorder with mixed symptom presentation
H65.01 Acute serous otitis media, right ear
H65.02 Acute serous otitis media, left ear
H65.03 Acute serous otitis media, bilateral
H65.04 Acute serous otitis media, recurrent, right ear
H65.05 Acute serous otitis media, recurrent, left ear
H65.06 Acute serous otitis media, recurrent, bilateral
H65.111 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear
H65.112 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), left ear
H65.113 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), bilateral
H65.114 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, right ear
H65.115 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, left ear
H65.116 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, bilateral
H65.191 Other acute nonsuppurative otitis media, right ear
H65.192 Other acute nonsuppurative otitis media, left ear
H65.193 Other acute nonsuppurative otitis media, bilateral
H65.194 Other acute nonsuppurative otitis media, recurrent, right ear
H65.195 Other acute nonsuppurative otitis media, recurrent, left ear
H65.196 Other acute nonsuppurative otitis media, recurrent, bilateral
H65.21 Chronic serous otitis media, right ear
H65.22 Chronic serous otitis media, left ear
H65.23 Chronic serous otitis media, bilateral
H65.31 Chronic mucoid otitis media, right ear
H65.32 Chronic mucoid otitis media, left ear
H65.33 Chronic mucoid otitis media, bilateral
H65.411 Chronic allergic otitis media, right ear
H65.412 Chronic allergic otitis media, left ear
H65.413 Chronic allergic otitis media, bilateral
H65.491 Other chronic nonsuppurative otitis media, right ear
H65.492 Other chronic nonsuppurative otitis media, left ear
H65.493 Other chronic nonsuppurative otitis media, bilateral
H65.91 Unspecified nonsuppurative otitis media, right ear
H65.92 Unspecified nonsuppurative otitis media, left ear
H65.93 Unspecified nonsuppurative otitis media, bilateral
H66.001 Acute suppurative otitis media without spontaneous rupture of ear drum, right ear
H66.002 Acute suppurative otitis media without spontaneous rupture of ear drum, left ear
H66.003 Acute suppurative otitis media without spontaneous rupture of ear drum, bilateral
H66.004 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear
H66.005 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left ear
H66.006 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, bilateral
H66.007 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, unspecified ear
H66.011 Acute suppurative otitis media with spontaneous rupture of ear drum, right ear
H66.012 Acute suppurative otitis media with spontaneous rupture of ear drum, left ear
H66.013 Acute suppurative otitis media with spontaneous rupture of ear drum, bilateral
H66.014 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, right ear
H66.015 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, left ear
H66.016 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, bilateral
H66.11 Chronic tubotympanic suppurative otitis media, right ear
H66.12 Chronic tubotympanic suppurative otitis media, left ear
H66.13 Chronic tubotympanic suppurative otitis media, bilateral
H66.21 Chronic atticoantral suppurative otitis media, right ear
H66.22 Chronic atticoantral suppurative otitis media, left ear
H66.23 Chronic atticoantral suppurative otitis media, bilateral
H66.3X1 Other chronic suppurative otitis media, right ear
H66.3X2 Other chronic suppurative otitis media, left ear
H66.3X3 Other chronic suppurative otitis media, bilateral
H66.41 Suppurative otitis media, unspecified, right ear
H66.42 Suppurative otitis media, unspecified, left ear
H66.43 Suppurative otitis media, unspecified, bilateral
H66.91 Otitis media, unspecified, right ear
H66.92 Otitis media, unspecified, left ear
H66.93 Otitis media, unspecified, bilateral
H67.1 Otitis media in diseases classified elsewhere, right ear
H67.2 Otitis media in diseases classified elsewhere, left ear
H67.3 Otitis media in diseases classified elsewhere, bilateral
H68.001 Unspecified Eustachian salpingitis, right ear
H68.002 Unspecified Eustachian salpingitis, left ear
H68.003 Unspecified Eustachian salpingitis, bilateral
H68.011 Acute Eustachian salpingitis, right ear
H68.012 Acute Eustachian salpingitis, left ear
H68.013 Acute Eustachian salpingitis, bilateral
H68.021 Chronic Eustachian salpingitis, right ear
H68.022 Chronic Eustachian salpingitis, left ear
H68.023 Chronic Eustachian salpingitis, bilateral
H68.101 Unspecified obstruction of Eustachian tube, right ear
H68.102 Unspecified obstruction of Eustachian tube, left ear
H68.103 Unspecified obstruction of Eustachian tube, bilateral
H68.111 Osseous obstruction of Eustachian tube, right ear
H68.112 Osseous obstruction of Eustachian tube, left ear
H68.113 Osseous obstruction of Eustachian tube, bilateral
H68.121 Intrinsic cartilagenous obstruction of Eustachian tube, right ear
H68.122 Intrinsic cartilagenous obstruction of Eustachian tube, left ear
H68.123 Intrinsic cartilagenous obstruction of Eustachian tube, bilateral
H68.131 Extrinsic cartilagenous obstruction of Eustachian tube, right ear
H68.132 Extrinsic cartilagenous obstruction of Eustachian tube, left ear
H68.133 Extrinsic cartilagenous obstruction of Eustachian tube, bilateral
H69.01 Patulous Eustachian tube, right ear
H69.02 Patulous Eustachian tube, left ear
H69.03 Patulous Eustachian tube, bilateral
H69.81 Other specified disorders of Eustachian tube, right ear
H69.82 Other specified disorders of Eustachian tube, left ear
H69.83 Other specified disorders of Eustachian tube, bilateral
H69.91 Unspecified Eustachian tube disorder, right ear
H69.92 Unspecified Eustachian tube disorder, left ear
H69.93 Unspecified Eustachian tube disorder, bilateral
H71.01 Cholesteatoma of attic, right ear
H71.02 Cholesteatoma of attic, left ear
H71.03 Cholesteatoma of attic, bilateral
H71.11 Cholesteatoma of tympanum, right ear
H71.12 Cholesteatoma of tympanum, left ear
H71.13 Cholesteatoma of tympanum, bilateral
H71.21 Cholesteatoma of mastoid, right ear
H71.22 Cholesteatoma of mastoid, left ear
H71.23 Cholesteatoma of mastoid, bilateral
H71.31 Diffuse cholesteatosis, right ear
H71.32 Diffuse cholesteatosis, left ear
H71.33 Diffuse cholesteatosis, bilateral
H71.91 Unspecified cholesteatoma, right ear
H71.92 Unspecified cholesteatoma, left ear
H71.93 Unspecified cholesteatoma, bilateral
H72.01 Central perforation of tympanic membrane, right ear
H72.02 Central perforation of tympanic membrane, left ear
H72.03 Central perforation of tympanic membrane, bilateral
H72.11 Attic perforation of tympanic membrane, right ear
H72.12 Attic perforation of tympanic membrane, left ear
H72.13 Attic perforation of tympanic membrane, bilateral
H72.2X1 Other marginal perforations of tympanic membrane, right ear
H72.2X2 Other marginal perforations of tympanic membrane, left ear
H72.2X3 Other marginal perforations of tympanic membrane, bilateral
H72.811 Multiple perforations of tympanic membrane, right ear
H72.812 Multiple perforations of tympanic membrane, left ear
H72.813 Multiple perforations of tympanic membrane, bilateral
H72.821 Total perforations of tympanic membrane, right ear
H72.822 Total perforations of tympanic membrane, left ear
H72.823 Total perforations of tympanic membrane, bilateral
H72.91 Unspecified perforation of tympanic membrane, right ear
H72.92 Unspecified perforation of tympanic membrane, left ear
H72.93 Unspecified perforation of tympanic membrane, bilateral
H74.01 Tympanosclerosis, right ear
H74.02 Tympanosclerosis, left ear
H74.03 Tympanosclerosis, bilateral
H74.11 Adhesive right middle ear disease
H74.12 Adhesive left middle ear disease
H74.13 Adhesive middle ear disease, bilateral
H74.21 Discontinuity and dislocation of right ear ossicles
H74.22 Discontinuity and dislocation of left ear ossicles
H74.23 Discontinuity and dislocation of ear ossicles, bilateral
H74.311 Ankylosis of ear ossicles, right ear
H74.312 Ankylosis of ear ossicles, left ear
H74.313 Ankylosis of ear ossicles, bilateral
H80.11 Otosclerosis involving oval window, obliterative, right ear
H80.12 Otosclerosis involving oval window, obliterative, left ear
H80.13 Otosclerosis involving oval window, obliterative, bilateral
H81.01 Meniere's disease, right ear
H81.02 Meniere's disease, left ear
H81.03 Meniere's disease, bilateral
H81.09 Meniere's disease, unspecified ear
H81.10 Benign paroxysmal vertigo, unspecified ear
H81.11 Benign paroxysmal vertigo, right ear
H81.12 Benign paroxysmal vertigo, left ear
H81.13 Benign paroxysmal vertigo, bilateral
H81.20 Vestibular neuronitis, unspecified ear
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
H81.319 Aural vertigo, unspecified ear
H81.391 Other peripheral vertigo, right ear
H81.392 Other peripheral vertigo, left ear
H81.393 Other peripheral vertigo, bilateral
H81.399 Other peripheral vertigo, unspecified ear
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
H81.8X9 Other disorders of vestibular function, unspecified ear
H81.90 Unspecified disorder of vestibular function, unspecified ear
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
H82.9 Vertiginous syndromes in diseases classified elsewhere, unspecified ear
H83.01 Labyrinthitis, right ear
H83.02 Labyrinthitis, left ear
H83.03 Labyrinthitis, bilateral
H83.09 Labyrinthitis, unspecified ear
H83.11 Labyrinthine fistula, right ear
H83.12 Labyrinthine fistula, left ear
H83.13 Labyrinthine fistula, bilateral
H83.19 Labyrinthine fistula, unspecified ear
H83.2X1 Labyrinthine dysfunction, right ear
H83.2X2 Labyrinthine dysfunction, left ear
H83.2X3 Labyrinthine dysfunction, bilateral
H83.2X9 Labyrinthine dysfunction, unspecified ear
H83.3X1 Noise effects on right inner ear
H83.3X2 Noise effects on left inner ear
H83.3X3 Noise effects on inner ear, bilateral
H83.3X9 Noise effects on inner ear, unspecified ear
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
H83.8X9 Other specified diseases of inner ear, unspecified ear
H83.90 Unspecified disease of inner ear, unspecified ear
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
H90.2 Conductive hearing loss, unspecified
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
H90.5* Unspecified sensorineural hearing loss
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
H90.8* Mixed conductive and sensorineural hearing loss, unspecified
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
H91.01 Ototoxic hearing loss, right ear
H91.02 Ototoxic hearing loss, left ear
H91.03 Ototoxic hearing loss, bilateral
H91.09 Ototoxic hearing loss, unspecified ear
H91.10 Presbycusis, unspecified ear
H91.11 Presbycusis, right ear
H91.12 Presbycusis, left ear
H91.13 Presbycusis, bilateral
H91.20 Sudden idiopathic hearing loss, unspecified ear
H91.21* Sudden idiopathic hearing loss, right ear
H91.22* Sudden idiopathic hearing loss, left ear
H91.23* Sudden idiopathic hearing loss, bilateral
H91.8X1 - H91.8X9 Other specified hearing loss, right ear - Other specified hearing loss, unspecified ear
H91.90 - H91.93 Unspecified hearing loss, unspecified ear - Unspecified hearing loss, bilateral
H93.11 Tinnitus, right ear
H93.12 Tinnitus, left ear
H93.13 Tinnitus, bilateral
H93.19 Tinnitus, unspecified ear
H93.241 Temporary auditory threshold shift, right ear
H93.242 Temporary auditory threshold shift, left ear
H93.243 Temporary auditory threshold shift, bilateral
H93.249 Temporary auditory threshold shift, unspecified ear
H93.291 Other abnormal auditory perceptions, right ear
H93.292 Other abnormal auditory perceptions, left ear
H93.293 Other abnormal auditory perceptions, bilateral
H93.299 Other abnormal auditory perceptions, unspecified ear
Z51.11 Encounter for antineoplastic chemotherapy
Z79.2 Long term (current) use of antibiotics
Group 2 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Tests for these ICD-10-CM codes are covered only for an initial evaluation of a hearing problem and for subsequent evaluation when the medical necessity is clearly documented in the patient’s medical record.

Group 3

Group 3 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code 92561:

Group 3 Codes
CodeDescription
D33.3 Benign neoplasm of cranial nerves
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
H90.2 Conductive hearing loss, unspecified
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
H90.5* Unspecified sensorineural hearing loss
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
H90.8* Mixed conductive and sensorineural hearing loss, unspecified
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
H91.01 Ototoxic hearing loss, right ear
H91.02 Ototoxic hearing loss, left ear
H91.03 Ototoxic hearing loss, bilateral
H91.09 Ototoxic hearing loss, unspecified ear
H91.10 Presbycusis, unspecified ear
H91.11 Presbycusis, right ear
H91.12 Presbycusis, left ear
H91.13 Presbycusis, bilateral
H91.20 Sudden idiopathic hearing loss, unspecified ear
H91.21* Sudden idiopathic hearing loss, right ear
H91.22* Sudden idiopathic hearing loss, left ear
H91.23* Sudden idiopathic hearing loss, bilateral
H91.8X1 - H91.8X9 Other specified hearing loss, right ear - Other specified hearing loss, unspecified ear
H91.90 - H91.93 Unspecified hearing loss, unspecified ear - Unspecified hearing loss, bilateral
Group 3 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Tests for these ICD-10-CM codes are covered only for an initial evaluation of a hearing problem and for subsequent evaluation when the medical necessity is clearly documented in the patient’s medical record.

Group 4

Group 4 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes 92562 and 92564:

Group 4 Codes
CodeDescription
H81.01 Meniere's disease, right ear
H81.02 Meniere's disease, left ear
H81.03 Meniere's disease, bilateral
H81.09 Meniere's disease, unspecified ear
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
H90.2 Conductive hearing loss, unspecified
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
H90.5* Unspecified sensorineural hearing loss
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
H90.8* Mixed conductive and sensorineural hearing loss, unspecified
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
H91.01 Ototoxic hearing loss, right ear
H91.02 Ototoxic hearing loss, left ear
H91.03 Ototoxic hearing loss, bilateral
H91.09 Ototoxic hearing loss, unspecified ear
H91.10 Presbycusis, unspecified ear
H91.11 Presbycusis, right ear
H91.12 Presbycusis, left ear
H91.13 Presbycusis, bilateral
H91.20 Sudden idiopathic hearing loss, unspecified ear
H91.21* Sudden idiopathic hearing loss, right ear
H91.22* Sudden idiopathic hearing loss, left ear
H91.23* Sudden idiopathic hearing loss, bilateral
H91.8X1 - H91.8X9 Other specified hearing loss, right ear - Other specified hearing loss, unspecified ear
H91.90 - H91.93 Unspecified hearing loss, unspecified ear - Unspecified hearing loss, bilateral
Group 4 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Tests for these ICD-10-CM codes are covered only for an initial evaluation of a hearing problem and for subsequent evaluation when the medical necessity is clearly documented in the patient’s medical record.

Group 5

Group 5 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code 92563:

Group 5 Codes
CodeDescription
D33.3 Benign neoplasm of cranial nerves
H65.01 Acute serous otitis media, right ear
H65.02 Acute serous otitis media, left ear
H65.03 Acute serous otitis media, bilateral
H65.04 Acute serous otitis media, recurrent, right ear
H65.05 Acute serous otitis media, recurrent, left ear
H65.06 Acute serous otitis media, recurrent, bilateral
H65.111 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear
H65.112 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), left ear
H65.113 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), bilateral
H65.114 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, right ear
H65.115 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, left ear
H65.116 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, bilateral
H65.191 Other acute nonsuppurative otitis media, right ear
H65.192 Other acute nonsuppurative otitis media, left ear
H65.193 Other acute nonsuppurative otitis media, bilateral
H65.194 Other acute nonsuppurative otitis media, recurrent, right ear
H65.195 Other acute nonsuppurative otitis media, recurrent, left ear
H65.196 Other acute nonsuppurative otitis media, recurrent, bilateral
H65.21 Chronic serous otitis media, right ear
H65.22 Chronic serous otitis media, left ear
H65.23 Chronic serous otitis media, bilateral
H65.31 Chronic mucoid otitis media, right ear
H65.32 Chronic mucoid otitis media, left ear
H65.33 Chronic mucoid otitis media, bilateral
H65.411 Chronic allergic otitis media, right ear
H65.412 Chronic allergic otitis media, left ear
H65.413 Chronic allergic otitis media, bilateral
H65.491 Other chronic nonsuppurative otitis media, right ear
H65.492 Other chronic nonsuppurative otitis media, left ear
H65.493 Other chronic nonsuppurative otitis media, bilateral
H65.91 Unspecified nonsuppurative otitis media, right ear
H65.92 Unspecified nonsuppurative otitis media, left ear
H65.93 Unspecified nonsuppurative otitis media, bilateral
H66.001 Acute suppurative otitis media without spontaneous rupture of ear drum, right ear
H66.002 Acute suppurative otitis media without spontaneous rupture of ear drum, left ear
H66.003 Acute suppurative otitis media without spontaneous rupture of ear drum, bilateral
H66.004 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear
H66.005 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left ear
H66.006 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, bilateral
H66.007 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, unspecified ear
H66.011 Acute suppurative otitis media with spontaneous rupture of ear drum, right ear
H66.012 Acute suppurative otitis media with spontaneous rupture of ear drum, left ear
H66.013 Acute suppurative otitis media with spontaneous rupture of ear drum, bilateral
H66.014 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, right ear
H66.015 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, left ear
H66.016 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, bilateral
H66.11 Chronic tubotympanic suppurative otitis media, right ear
H66.12 Chronic tubotympanic suppurative otitis media, left ear
H66.13 Chronic tubotympanic suppurative otitis media, bilateral
H66.21 Chronic atticoantral suppurative otitis media, right ear
H66.22 Chronic atticoantral suppurative otitis media, left ear
H66.23 Chronic atticoantral suppurative otitis media, bilateral
H66.3X1 Other chronic suppurative otitis media, right ear
H66.3X2 Other chronic suppurative otitis media, left ear
H66.3X3 Other chronic suppurative otitis media, bilateral
H66.41 Suppurative otitis media, unspecified, right ear
H66.42 Suppurative otitis media, unspecified, left ear
H66.43 Suppurative otitis media, unspecified, bilateral
H66.91 Otitis media, unspecified, right ear
H66.92 Otitis media, unspecified, left ear
H66.93 Otitis media, unspecified, bilateral
H67.1 Otitis media in diseases classified elsewhere, right ear
H67.2 Otitis media in diseases classified elsewhere, left ear
H67.3 Otitis media in diseases classified elsewhere, bilateral
H68.001 Unspecified Eustachian salpingitis, right ear
H68.002 Unspecified Eustachian salpingitis, left ear
H68.003 Unspecified Eustachian salpingitis, bilateral
H68.011 Acute Eustachian salpingitis, right ear
H68.012 Acute Eustachian salpingitis, left ear
H68.013 Acute Eustachian salpingitis, bilateral
H68.021 Chronic Eustachian salpingitis, right ear
H68.022 Chronic Eustachian salpingitis, left ear
H68.023 Chronic Eustachian salpingitis, bilateral
H68.101 Unspecified obstruction of Eustachian tube, right ear
H68.102 Unspecified obstruction of Eustachian tube, left ear
H68.103 Unspecified obstruction of Eustachian tube, bilateral
H68.111 Osseous obstruction of Eustachian tube, right ear
H68.112 Osseous obstruction of Eustachian tube, left ear
H68.113 Osseous obstruction of Eustachian tube, bilateral
H68.121 Intrinsic cartilagenous obstruction of Eustachian tube, right ear
H68.122 Intrinsic cartilagenous obstruction of Eustachian tube, left ear
H68.123 Intrinsic cartilagenous obstruction of Eustachian tube, bilateral
H68.131 Extrinsic cartilagenous obstruction of Eustachian tube, right ear
H68.132 Extrinsic cartilagenous obstruction of Eustachian tube, left ear
H68.133 Extrinsic cartilagenous obstruction of Eustachian tube, bilateral
H69.01 Patulous Eustachian tube, right ear
H69.02 Patulous Eustachian tube, left ear
H69.03 Patulous Eustachian tube, bilateral
H69.81 Other specified disorders of Eustachian tube, right ear
H69.82 Other specified disorders of Eustachian tube, left ear
H69.83 Other specified disorders of Eustachian tube, bilateral
H69.91 Unspecified Eustachian tube disorder, right ear
H69.92 Unspecified Eustachian tube disorder, left ear
H69.93 Unspecified Eustachian tube disorder, bilateral
H71.01 Cholesteatoma of attic, right ear
H71.02 Cholesteatoma of attic, left ear
H71.03 Cholesteatoma of attic, bilateral
H71.11 Cholesteatoma of tympanum, right ear
H71.12 Cholesteatoma of tympanum, left ear
H71.13 Cholesteatoma of tympanum, bilateral
H71.21 Cholesteatoma of mastoid, right ear
H71.22 Cholesteatoma of mastoid, left ear
H71.23 Cholesteatoma of mastoid, bilateral
H71.31 Diffuse cholesteatosis, right ear
H71.32 Diffuse cholesteatosis, left ear
H71.33 Diffuse cholesteatosis, bilateral
H71.91 Unspecified cholesteatoma, right ear
H71.92 Unspecified cholesteatoma, left ear
H71.93 Unspecified cholesteatoma, bilateral
H72.01 Central perforation of tympanic membrane, right ear
H72.02 Central perforation of tympanic membrane, left ear
H72.03 Central perforation of tympanic membrane, bilateral
H72.11 Attic perforation of tympanic membrane, right ear
H72.12 Attic perforation of tympanic membrane, left ear
H72.13 Attic perforation of tympanic membrane, bilateral
H72.2X1 Other marginal perforations of tympanic membrane, right ear
H72.2X2 Other marginal perforations of tympanic membrane, left ear
H72.2X3 Other marginal perforations of tympanic membrane, bilateral
H72.811 Multiple perforations of tympanic membrane, right ear
H72.812 Multiple perforations of tympanic membrane, left ear
H72.813 Multiple perforations of tympanic membrane, bilateral
H72.821 Total perforations of tympanic membrane, right ear
H72.822 Total perforations of tympanic membrane, left ear
H72.823 Total perforations of tympanic membrane, bilateral
H72.91 Unspecified perforation of tympanic membrane, right ear
H72.92 Unspecified perforation of tympanic membrane, left ear
H72.93 Unspecified perforation of tympanic membrane, bilateral
H74.01 Tympanosclerosis, right ear
H74.02 Tympanosclerosis, left ear
H74.03 Tympanosclerosis, bilateral
H74.11 Adhesive right middle ear disease
H74.12 Adhesive left middle ear disease
H74.13 Adhesive middle ear disease, bilateral
H74.21 Discontinuity and dislocation of right ear ossicles
H74.22 Discontinuity and dislocation of left ear ossicles
H74.23 Discontinuity and dislocation of ear ossicles, bilateral
H74.311 Ankylosis of ear ossicles, right ear
H74.312 Ankylosis of ear ossicles, left ear
H74.313 Ankylosis of ear ossicles, bilateral
H80.11 Otosclerosis involving oval window, obliterative, right ear
H80.12 Otosclerosis involving oval window, obliterative, left ear
H80.13 Otosclerosis involving oval window, obliterative, bilateral
H81.01 Meniere's disease, right ear
H81.02 Meniere's disease, left ear
H81.03 Meniere's disease, bilateral
H81.09 Meniere's disease, unspecified ear
H81.10 Benign paroxysmal vertigo, unspecified ear
H81.11 Benign paroxysmal vertigo, right ear
H81.12 Benign paroxysmal vertigo, left ear
H81.13 Benign paroxysmal vertigo, bilateral
H81.20 Vestibular neuronitis, unspecified ear
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
H81.319 Aural vertigo, unspecified ear
H81.391 Other peripheral vertigo, right ear
H81.392 Other peripheral vertigo, left ear
H81.393 Other peripheral vertigo, bilateral
H81.399 Other peripheral vertigo, unspecified ear
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
H81.8X9 Other disorders of vestibular function, unspecified ear
H81.90 Unspecified disorder of vestibular function, unspecified ear
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
H82.9 Vertiginous syndromes in diseases classified elsewhere, unspecified ear
H83.01 Labyrinthitis, right ear
H83.02 Labyrinthitis, left ear
H83.03 Labyrinthitis, bilateral
H83.09 Labyrinthitis, unspecified ear
H83.11 Labyrinthine fistula, right ear
H83.12 Labyrinthine fistula, left ear
H83.13 Labyrinthine fistula, bilateral
H83.19 Labyrinthine fistula, unspecified ear
H83.2X1 Labyrinthine dysfunction, right ear
H83.2X2 Labyrinthine dysfunction, left ear
H83.2X3 Labyrinthine dysfunction, bilateral
H83.2X9 Labyrinthine dysfunction, unspecified ear
H83.3X1 Noise effects on right inner ear
H83.3X2 Noise effects on left inner ear
H83.3X3 Noise effects on inner ear, bilateral
H83.3X9 Noise effects on inner ear, unspecified ear
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
H83.8X9 Other specified diseases of inner ear, unspecified ear
H83.90 Unspecified disease of inner ear, unspecified ear
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
H90.2 Conductive hearing loss, unspecified
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
H90.5* Unspecified sensorineural hearing loss
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
H90.8* Mixed conductive and sensorineural hearing loss, unspecified
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
H91.01 Ototoxic hearing loss, right ear
H91.02 Ototoxic hearing loss, left ear
H91.03 Ototoxic hearing loss, bilateral
H91.09 Ototoxic hearing loss, unspecified ear
H91.10 Presbycusis, unspecified ear
H91.11 Presbycusis, right ear
H91.12 Presbycusis, left ear
H91.13 Presbycusis, bilateral
H91.20 Sudden idiopathic hearing loss, unspecified ear
H91.21* Sudden idiopathic hearing loss, right ear
H91.22* Sudden idiopathic hearing loss, left ear
H91.23* Sudden idiopathic hearing loss, bilateral
H91.8X1 - H91.8X9 Other specified hearing loss, right ear - Other specified hearing loss, unspecified ear
H91.90 - H91.93 Unspecified hearing loss, unspecified ear - Unspecified hearing loss, bilateral
H93.11 Tinnitus, right ear
H93.12 Tinnitus, left ear
H93.13 Tinnitus, bilateral
H93.19 Tinnitus, unspecified ear
H93.249 Temporary auditory threshold shift, unspecified ear
Group 5 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Tests for these ICD-10-CM codes are covered only for an initial evaluation of a hearing problem and for subsequent evaluation when the medical necessity is clearly documented in the patient’s medical record.

Group 6

Group 6 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes 92565 and 92577:

Group 6 Codes
CodeDescription
F44.4 Conversion disorder with motor symptom or deficit
F44.6 Conversion disorder with sensory symptom or deficit
F44.7 Conversion disorder with mixed symptom presentation
F44.9 Dissociative and conversion disorder, unspecified
Z76.5 Malingerer [conscious simulation]

Group 7

Group 7 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes 92571, 92572, 92576, 92620 and 92621:

Group 7 Codes
CodeDescription
H80.11 Otosclerosis involving oval window, obliterative, right ear
H80.12 Otosclerosis involving oval window, obliterative, left ear
H80.13 Otosclerosis involving oval window, obliterative, bilateral
H81.01 Meniere's disease, right ear
H81.02 Meniere's disease, left ear
H81.03 Meniere's disease, bilateral
H81.09 Meniere's disease, unspecified ear
H81.10 Benign paroxysmal vertigo, unspecified ear
H81.11 Benign paroxysmal vertigo, right ear
H81.12 Benign paroxysmal vertigo, left ear
H81.13 Benign paroxysmal vertigo, bilateral
H81.20 Vestibular neuronitis, unspecified ear
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
H81.319 Aural vertigo, unspecified ear
H81.391 Other peripheral vertigo, right ear
H81.392 Other peripheral vertigo, left ear
H81.393 Other peripheral vertigo, bilateral
H81.399 Other peripheral vertigo, unspecified ear
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
H81.8X9 Other disorders of vestibular function, unspecified ear
H81.90 Unspecified disorder of vestibular function, unspecified ear
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
H82.9 Vertiginous syndromes in diseases classified elsewhere, unspecified ear
H83.01 Labyrinthitis, right ear
H83.02 Labyrinthitis, left ear
H83.03 Labyrinthitis, bilateral
H83.09 Labyrinthitis, unspecified ear
H83.11 Labyrinthine fistula, right ear
H83.12 Labyrinthine fistula, left ear
H83.13 Labyrinthine fistula, bilateral
H83.19 Labyrinthine fistula, unspecified ear
H83.2X1 Labyrinthine dysfunction, right ear
H83.2X2 Labyrinthine dysfunction, left ear
H83.2X3 Labyrinthine dysfunction, bilateral
H83.2X9 Labyrinthine dysfunction, unspecified ear
H83.3X1 Noise effects on right inner ear
H83.3X2 Noise effects on left inner ear
H83.3X3 Noise effects on inner ear, bilateral
H83.3X9 Noise effects on inner ear, unspecified ear
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
H83.8X9 Other specified diseases of inner ear, unspecified ear
H83.90 Unspecified disease of inner ear, unspecified ear
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
H90.2 Conductive hearing loss, unspecified
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
H90.5* Unspecified sensorineural hearing loss
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
H90.8* Mixed conductive and sensorineural hearing loss, unspecified
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
H91.01 Ototoxic hearing loss, right ear
H91.02 Ototoxic hearing loss, left ear
H91.03 Ototoxic hearing loss, bilateral
H91.09 Ototoxic hearing loss, unspecified ear
H91.10 Presbycusis, unspecified ear
H91.11 Presbycusis, right ear
H91.12 Presbycusis, left ear
H91.13 Presbycusis, bilateral
H91.20 Sudden idiopathic hearing loss, unspecified ear
H91.21* Sudden idiopathic hearing loss, right ear
H91.22* Sudden idiopathic hearing loss, left ear
H91.23* Sudden idiopathic hearing loss, bilateral
H91.8X1 - H91.8X9 Other specified hearing loss, right ear - Other specified hearing loss, unspecified ear
H91.90 - H91.93 Unspecified hearing loss, unspecified ear - Unspecified hearing loss, bilateral
H93.11 Tinnitus, right ear
H93.12 Tinnitus, left ear
H93.13 Tinnitus, bilateral
H93.19 Tinnitus, unspecified ear
Group 7 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Tests for these ICD-10-CM codes are covered only for an initial evaluation of a hearing problem and for subsequent evaluation when the medical necessity is clearly documented in the patient’s medical record.

Group 8

Group 8 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code 92575:

Group 8 Codes
CodeDescription
H81.01 Meniere's disease, right ear
H81.02 Meniere's disease, left ear
H81.03 Meniere's disease, bilateral
H81.09 Meniere's disease, unspecified ear
H81.10 Benign paroxysmal vertigo, unspecified ear
H81.11 Benign paroxysmal vertigo, right ear
H81.12 Benign paroxysmal vertigo, left ear
H81.13 Benign paroxysmal vertigo, bilateral
H81.20 Vestibular neuronitis, unspecified ear
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
H81.319 Aural vertigo, unspecified ear
H81.391 Other peripheral vertigo, right ear
H81.392 Other peripheral vertigo, left ear
H81.393 Other peripheral vertigo, bilateral
H81.399 Other peripheral vertigo, unspecified ear
H81.4 Vertigo of central origin
H81.90 - H81.93 Unspecified disorder of vestibular function, unspecified ear - Unspecified disorder of vestibular function, bilateral
H83.01 Labyrinthitis, right ear
H83.02 Labyrinthitis, left ear
H83.03 Labyrinthitis, bilateral
H83.09 Labyrinthitis, unspecified ear
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
H90.2 Conductive hearing loss, unspecified
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
H90.5* Unspecified sensorineural hearing loss
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
H90.8* Mixed conductive and sensorineural hearing loss, unspecified
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
H91.01 Ototoxic hearing loss, right ear
H91.02 Ototoxic hearing loss, left ear
H91.03 Ototoxic hearing loss, bilateral
H91.09 Ototoxic hearing loss, unspecified ear
H91.10 Presbycusis, unspecified ear
H91.11 Presbycusis, right ear
H91.12 Presbycusis, left ear
H91.13 Presbycusis, bilateral
H91.20 Sudden idiopathic hearing loss, unspecified ear
H91.21* Sudden idiopathic hearing loss, right ear
H91.22* Sudden idiopathic hearing loss, left ear
H91.23* Sudden idiopathic hearing loss, bilateral
H91.8X1 - H91.8X9 Other specified hearing loss, right ear - Other specified hearing loss, unspecified ear
H91.90 - H91.93 Unspecified hearing loss, unspecified ear - Unspecified hearing loss, bilateral
H93.11 Tinnitus, right ear
H93.12 Tinnitus, left ear
H93.13 Tinnitus, bilateral
H93.19 Tinnitus, unspecified ear
H93.90 Unspecified disorder of ear, unspecified ear
Group 8 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Tests for these ICD-10-CM codes are covered only for an initial evaluation of a hearing problem and for subsequent evaluation when the medical necessity is clearly documented in the patient’s medical record.

Group 9

Group 9 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes 92582 and 92583:

Group 9 Codes
CodeDescription
F70 Mild intellectual disabilities
F71 Moderate intellectual disabilities
F72 Severe intellectual disabilities
F73 Profound intellectual disabilities
F78.A9 Other genetic related intellectual disability
F79 Unspecified intellectual disabilities

Group 10

Group 10 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code 92584:

Group 10 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
H81.09 Meniere's disease, unspecified ear
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
H90.2 Conductive hearing loss, unspecified
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
H90.5* Unspecified sensorineural hearing loss
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
H90.8* Mixed conductive and sensorineural hearing loss, unspecified
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
H91.01 Ototoxic hearing loss, right ear
H91.02 Ototoxic hearing loss, left ear
H91.03 Ototoxic hearing loss, bilateral
H91.09 Ototoxic hearing loss, unspecified ear
H91.10 Presbycusis, unspecified ear
H91.11 Presbycusis, right ear
H91.12 Presbycusis, left ear
H91.13 Presbycusis, bilateral
H91.20 Sudden idiopathic hearing loss, unspecified ear
H91.21* Sudden idiopathic hearing loss, right ear
H91.22* Sudden idiopathic hearing loss, left ear
H91.23* Sudden idiopathic hearing loss, bilateral
H91.8X1 - H91.8X9 Other specified hearing loss, right ear - Other specified hearing loss, unspecified ear
H91.90 - H91.93 Unspecified hearing loss, unspecified ear - Unspecified hearing loss, bilateral
H93.11 Tinnitus, right ear
H93.12 Tinnitus, left ear
H93.13 Tinnitus, bilateral
H93.19 Tinnitus, unspecified ear
Group 10 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Tests for these ICD-10-CM codes are covered only for an initial evaluation of a hearing problem and for subsequent evaluation when the medical necessity is clearly documented in the patient’s medical record.

Group 11

Group 11 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes 92651, 92652, and 92653:

Group 11 Codes
CodeDescription
C71.6 Malignant neoplasm of cerebellum
D33.1 Benign neoplasm of brain, infratentorial
D33.3 Benign neoplasm of cranial nerves
D43.1 Neoplasm of uncertain behavior of brain, infratentorial
G10 Huntington's disease
G21.0 Malignant neuroleptic syndrome
G23.0 Hallervorden-Spatz disease
G23.1 Progressive supranuclear ophthalmoplegia [Steele-Richardson-Olszewski]
G23.2 Striatonigral degeneration
G23.8 Other specified degenerative diseases of basal ganglia
G23.9 Degenerative disease of basal ganglia, unspecified
G24.01 Drug induced subacute dyskinesia
G24.02 Drug induced acute dystonia
G24.09 Other drug induced dystonia
G24.1 Genetic torsion dystonia
G24.2 Idiopathic nonfamilial dystonia
G24.3 Spasmodic torticollis
G24.4 Idiopathic orofacial dystonia
G24.5 Blepharospasm
G24.8 Other dystonia
G24.9 Dystonia, unspecified
G25.0 Essential tremor
G25.1 Drug-induced tremor
G25.2 Other specified forms of tremor
G25.3 Myoclonus
G25.4 Drug-induced chorea
G25.5 Other chorea
G25.61 Drug induced tics
G25.69 Other tics of organic origin
G25.70 Drug induced movement disorder, unspecified
G25.71 Drug induced akathisia
G25.79 Other drug induced movement disorders
G25.81 Restless legs syndrome
G25.82 Stiff-man syndrome
G25.83 Benign shuddering attacks
G25.89 Other specified extrapyramidal and movement disorders
G26 Extrapyramidal and movement disorders in diseases classified elsewhere
G35 Multiple sclerosis
G36.0 Neuromyelitis optica [Devic]
G36.1 Acute and subacute hemorrhagic leukoencephalitis [Hurst]
G36.8 Other specified acute disseminated demyelination
G37.0 Diffuse sclerosis of central nervous system
G37.1 Central demyelination of corpus callosum
G37.2 Central pontine myelinolysis
G37.3 Acute transverse myelitis in demyelinating disease of central nervous system
G37.4 Subacute necrotizing myelitis of central nervous system
G37.5 Concentric sclerosis [Balo] of central nervous system
G37.8 Other specified demyelinating diseases of central nervous system
G37.9 Demyelinating disease of central nervous system, unspecified
G80.3 Athetoid cerebral palsy
G90.3 Multi-system degeneration of the autonomic nervous system
H46.00 Optic papillitis, unspecified eye
H46.01 Optic papillitis, right eye
H46.02 Optic papillitis, left eye
H46.03 Optic papillitis, bilateral
H46.10 Retrobulbar neuritis, unspecified eye
H46.11 Retrobulbar neuritis, right eye
H46.12 Retrobulbar neuritis, left eye
H46.13 Retrobulbar neuritis, bilateral
H46.2 Nutritional optic neuropathy
H46.3 Toxic optic neuropathy
H46.8 Other optic neuritis
H46.9 Unspecified optic neuritis
H81.01 Meniere's disease, right ear
H81.02 Meniere's disease, left ear
H81.03 Meniere's disease, bilateral
H81.09 Meniere's disease, unspecified ear
H81.4 Vertigo of central origin
H83.3X1 Noise effects on right inner ear
H83.3X2 Noise effects on left inner ear
H83.3X3 Noise effects on inner ear, bilateral
H83.3X9 Noise effects on inner ear, unspecified ear
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
H90.2 Conductive hearing loss, unspecified
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
H90.5 Unspecified sensorineural hearing loss
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
H90.8 Mixed conductive and sensorineural hearing loss, unspecified
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
H91.01 Ototoxic hearing loss, right ear
H91.02 Ototoxic hearing loss, left ear
H91.03 Ototoxic hearing loss, bilateral
H91.09 Ototoxic hearing loss, unspecified ear
H91.10 Presbycusis, unspecified ear
H91.11 Presbycusis, right ear
H91.12 Presbycusis, left ear
H91.13 Presbycusis, bilateral
H91.20 Sudden idiopathic hearing loss, unspecified ear
H91.21* Sudden idiopathic hearing loss, right ear
H91.22* Sudden idiopathic hearing loss, left ear
H91.23* Sudden idiopathic hearing loss, bilateral
H91.3 Deaf nonspeaking, not elsewhere classified
H91.8X1 - H91.8X9 Other specified hearing loss, right ear - Other specified hearing loss, unspecified ear
H91.90 - H91.93 Unspecified hearing loss, unspecified ear - Unspecified hearing loss, bilateral
H93.011 Transient ischemic deafness, right ear
H93.012 Transient ischemic deafness, left ear
H93.013 Transient ischemic deafness, bilateral
H93.019 Transient ischemic deafness, unspecified ear
H93.091 Unspecified degenerative and vascular disorders of right ear
H93.092 Unspecified degenerative and vascular disorders of left ear
H93.093 Unspecified degenerative and vascular disorders of ear, bilateral
H93.099 Unspecified degenerative and vascular disorders of unspecified ear
H93.11 Tinnitus, right ear
H93.12 Tinnitus, left ear
H93.13 Tinnitus, bilateral
H93.19 Tinnitus, unspecified ear
H93.211 Auditory recruitment, right ear
H93.212 Auditory recruitment, left ear
H93.213 Auditory recruitment, bilateral
H93.219 Auditory recruitment, unspecified ear
H93.221 Diplacusis, right ear
H93.222 Diplacusis, left ear
H93.223 Diplacusis, bilateral
H93.229 Diplacusis, unspecified ear
H93.231 Hyperacusis, right ear
H93.232 Hyperacusis, left ear
H93.233 Hyperacusis, bilateral
H93.239 Hyperacusis, unspecified ear
H93.241 Temporary auditory threshold shift, right ear
H93.242 Temporary auditory threshold shift, left ear
H93.243 Temporary auditory threshold shift, bilateral
H93.249 Temporary auditory threshold shift, unspecified ear
H93.25 Central auditory processing disorder
H93.291 Other abnormal auditory perceptions, right ear
H93.292 Other abnormal auditory perceptions, left ear
H93.293 Other abnormal auditory perceptions, bilateral
H93.299 Other abnormal auditory perceptions, unspecified ear
H93.3X1 Disorders of right acoustic nerve
H93.3X2 Disorders of left acoustic nerve
H93.3X3 Disorders of bilateral acoustic nerves
H93.3X9 Disorders of unspecified acoustic nerve
H94.00 Acoustic neuritis in infectious and parasitic diseases classified elsewhere, unspecified ear
H94.01 Acoustic neuritis in infectious and parasitic diseases classified elsewhere, right ear
H94.02 Acoustic neuritis in infectious and parasitic diseases classified elsewhere, left ear
H94.03 Acoustic neuritis in infectious and parasitic diseases classified elsewhere, bilateral
R25.0 Abnormal head movements
R25.1 Tremor, unspecified
R25.2 Cramp and spasm
R25.3 Fasciculation
R25.8 Other abnormal involuntary movements
R25.9 Unspecified abnormal involuntary movements
R42 Dizziness and giddiness
Z01.12 Encounter for hearing conservation and treatment
Z01.818 Encounter for other preprocedural examination
Z45.321 Encounter for adjustment and management of cochlear device
Group 11 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Tests for these ICD-10-CM codes are covered only for an initial evaluation of a hearing problem and for subsequent evaluation when the medical necessity is clearly documented in the patient’s medical record.

Group 12

Group 12 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes 92579, 92587 and 92588:

Group 12 Codes
CodeDescription
H83.3X1 Noise effects on right inner ear
H83.3X2 Noise effects on left inner ear
H83.3X3 Noise effects on inner ear, bilateral
H83.3X9 Noise effects on inner ear, unspecified ear
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
H90.2 Conductive hearing loss, unspecified
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
H90.5* Unspecified sensorineural hearing loss
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
H90.8* Mixed conductive and sensorineural hearing loss, unspecified
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
H91.01 Ototoxic hearing loss, right ear
H91.02 Ototoxic hearing loss, left ear
H91.03 Ototoxic hearing loss, bilateral
H91.09 Ototoxic hearing loss, unspecified ear
H91.10 Presbycusis, unspecified ear
H91.11 Presbycusis, right ear
H91.12 Presbycusis, left ear
H91.13 Presbycusis, bilateral
H91.20 Sudden idiopathic hearing loss, unspecified ear
H91.21* Sudden idiopathic hearing loss, right ear
H91.22* Sudden idiopathic hearing loss, left ear
H91.23* Sudden idiopathic hearing loss, bilateral
H91.8X1 - H91.8X9 Other specified hearing loss, right ear - Other specified hearing loss, unspecified ear
H91.90 - H91.93 Unspecified hearing loss, unspecified ear - Unspecified hearing loss, bilateral
H93.11 Tinnitus, right ear
H93.12 Tinnitus, left ear
H93.13 Tinnitus, bilateral
H93.19 Tinnitus, unspecified ear
Group 12 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Tests for these ICD-10-CM codes are covered only for an initial evaluation of a hearing problem and for subsequent evaluation when the medical necessity is clearly documented in the patient’s medical record.

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

Group 1

Group 1 Paragraph

All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.

Group 1 Codes

N/A

ICD-10-PCS Codes

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.

CodeDescription
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
018x Hospital - Swing Beds
021x Skilled Nursing - Inpatient (Including Medicare Part A)
022x Skilled Nursing - Inpatient (Medicare Part B only)
023x Skilled Nursing - Outpatient
028x Skilled Nursing - Swing Beds
073x Clinic - Freestanding
077x Clinic - Federally Qualified Health Center (FQHC)
085x Critical Access Hospital

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.

Note: The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this article. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Pub.100-04, Claims Processing Manual, for further guidance.


CodeDescription
0470 Audiology - General Classification
0471 Audiology - Diagnostic
0472 Audiology - Treatment
0479 Audiology - Other Audiology
0960 Professional Fees - General Classification
0982 Professional Fees - Outpatient Services
0983 Professional Fees - Clinic

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/01/2021 R3

Article revised and published on 10/14/2021 effective for dates of service on and after 10/01/2021 to reflect the Annual ICD-10-CM Code Updates.

The following ICD-10-CM code has been added to the Article: F78.A9 to Group 9. The following ICD-10 code has been deleted and therefore has been removed from the article: F78 from Group 9.

01/01/2021 R2

Article revised and published on 02/11/2021 effective for dates of service on and after 01/01/2021 to reflect the Annual HCPCS/CPT Code Updates. The following CPT codes have been added to the article: 92651, 92652, and 92653 in the ‘Coding Guidance’ section, the Group 11 CPT Codes, and the Group 11 Paragraph for ICD-10 Codes. The following CPT codes have been deleted and therefore have been removed from the article: 92585 and 92586 in the ‘Coding Guidance’ section, the Group 11 CPT Codes, and the Group 11 Paragraph for ICD-10 Codes. Minor formatting changes have been made throughout the coding section.

10/01/2019 R1

Consistent with CMS Change Request 10901, article created and posted on 10/17/2019 effective for dates of service 10/01/2019 and after to add coding and billing instruction. All codes have been moved from the LCD to the article. In response to the Annual ICD-10-CM update The following ICD-10 codes have been deleted and therefore have not been included in the article: H81.41, H81.42, H81.43 and H81.49. ICD-10 code H81.4 has been added to ICD-10 code groups 1, 2, 5, 7, 8 and 11.

Associated Documents

Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
10/08/2021 10/01/2021 - N/A Currently in Effect You are here
02/05/2021 01/01/2021 - 09/30/2021 Superseded View
10/11/2019 10/01/2019 - 12/31/2020 Superseded View
10/10/2019 10/01/2019 - N/A Superseded View

Keywords

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