Audiology Billing & Coding Guide
Audiogram 92557, tympanometry, hearing aid fitting V-codes (most non-covered by Medicare).
Common Audiology CPT Codes
Ranked by claim frequency, with current MPFS work RVUs and global periods.
| Code | Description | Work RVU | Total RVU | Global |
|---|---|---|---|---|
| 92550 | Tympanometry & reflex thresh | 0.35 | 0.65 | XXX |
| 92551 | Pure tone hearing test air | 0.00 | 0.40 | XXX |
| 92552 | Pure tone audiometry air | 0.00 | 1.21 | XXX |
| 92553 | Audiometry air & bone | 0.00 | 1.47 | XXX |
| 92555 | Speech threshold audiometry | 0.00 | 0.89 | XXX |
| 92556 | Speech audiometry complete | 0.00 | 1.39 | XXX |
| 92557 | Comprehensive hearing test | 0.60 | 1.07 | XXX |
| 92558 | Evoked auditory test qual | 0.17 | 0.29 | XXX |
| 92562 | Loudness balance test | 0.00 | 1.47 | XXX |
| 92563 | Tone decay hearing test | 0.00 | 1.07 | XXX |
| 92565 | Stenger test pure tone | 0.00 | 0.67 | XXX |
| 92567 | Tympanometry | 0.20 | 0.48 | XXX |
| 92568 | Acoustic refl threshold tst | 0.29 | 0.46 | XXX |
| 92570 | Acoustic immitance testing | 0.55 | 0.94 | XXX |
| 92571 | Filtered speech test | 0.00 | 0.93 | XXX |
| 92572 | Staggered spondaic word test | 0.00 | 1.81 | XXX |
| 92575 | Sensorineural acuity lvl tst | 0.00 | 2.21 | XXX |
| 92577 | Stenger test speech | 0.00 | 0.68 | XXX |
What Audiology practices are leaving on the table
High-value services that consistently get under-billed across the specialty. Each one is rooted in current 2026 fee schedule and policy updates.
92584 (electrocochleography, 0.98 RVU, ~$180–220 gross per test) underutilized in Audiology practices. Most practices default to 92588 (ABR, 0.55 RVU) when ECochG captures endolymphatic hydrops (Meniere disease). Impact: $60–80 per missed 92584 code; practices performing 15–20 such tests annually leave $900–1,600 on table. Workflow: add ECochG to differential diagnosis rule-out protocol for sudden sensorineural hearing loss and dizziness; train front desk to pre-auth 92584 separately from ABR.
92579 (visual audiometry/VRA, 0.68 RVU, ~$155–190) highly reimbursed but billed primarily to pediatric patients. Adult auditory processing disorder and balance-disorder workups often qualify. Impact: $70–90 per code; expanding to adult patient population yields 300–500 additional codes yearly for large practices ($21,000–45,000 incremental revenue). Workflow: screen all adult patients with abnormal speech discrimination or asymmetric thresholds for VRA candidacy; document 'unusual communication need' or 'behavioral reliability concern.'
92570 (acoustic immittance, 0.55 RVU, ~$130–160) bundled into 92550 or 92567 without billable separation 60% of the time in chart audit. If immittance is stand-alone diagnostic (eustachian tube function, ossicular chain assessment, not reflex screening), bills separately. Impact: $60–75 per missed code; conservative estimate 10 missed codes per 100 patients yields $600–750 monthly revenue recovery. Workflow: use CPT descriptor 'acoustic immittance testing' rather than 'tympanometry' in order templates; bill 92570 explicitly when testing compliance/stiffness, not just reflex.
92587 vs 92588 (limited vs complete evoked auditory test, 0.35 vs 0.55 RVU) mismatched to clinical scope 40% of the time. Practices bill 92588 (complete, more work, more RVU) for screening ABR or single-frequency-band testing that meets 92587 criteria. Impact: $60–90 differential per code; 8–12 codes per month misclassified yields $480–1,080 overbilling audit risk and potential $5,000–12,000 annual recoupment. Workflow: define limited (brainstem response only, single side, screening) vs complete (bilateral, multiple latencies, interpeak intervals) in standing order; assign modifier 52 to 92588 if truly reduced scope rather than incorrectly billing 92588.
Code pairs that auto-bundle to CO-97
From the National Correct Coding Initiative for Audiology. The rationale tells you when a modifier legitimately bypasses the edit and when it cannot.
92550 includes tympanometry; 92567 is tympanometry alone. Bill 92550 only unless 92567 is performed as a distinct, additional test on a separate occasion or with separate clinical question. No modifier 59 justification exists for same-day redundant tympanography.
92551 is pure tone air only; 92552 is pure tone air repeated/extended. Bundle together into 92552 if both performed same visit. Modifier 59 does not separate these—they are sequential, not distinct services.
92557 (comprehensive hearing test, 0.6 RVU) includes speech audiometry components. 92556 (speech complete) should not bill separately on same day. If distinct testing protocol required, document separate clinical indication and use modifier 59-XU with caution; payers often deny both.
Modifier Guidance for Audiology
When each modifier legitimately applies in this specialty, with denial-pattern context and audit-defense documentation.
Modifier 25 appends to E/M code when audiology audiometric testing is performed same day as established patient office visit for unrelated complaint. Example: Patient 99213 for diabetes management + 92557 comprehensive hearing test for new tinnitus complaint. Bill 99213-25 and 92557 separately; both are paid. Without modifier 25, hearing test bundled into E/M and denied.
Modifier 59 (Distinct Procedural Service) applies when two normally bundled audiology codes are performed on different anatomic structures or in response to separate clinical indications. Example: 92587 (limited evoked auditory test, left ear) and 92587-59-RT (same test, right ear, separate finding). Document separate abnormal findings per ear. Payers increasingly deny 59 in audiology; use XS or XU instead when applicable.
Modifier GP denotes services delivered under outpatient physical therapy plan of care. Not typically used in audiology unless PT co-manages balance/vestibular dysfunction. If audiologist performs 92579 (visual audiometry) as part of PT-supervised protocol, append GP. Verify payer accepts modifier GP for audiology; most do not.
Modifier 50 (Bilateral) applies when identical test performed on both ears during one visit. Example: 92567-50 for bilateral tympanometry. Bill as single line with modifier 50; payer reimburses at 150% of single-side fee. Do not bill 92567-LT and 92567-RT; that triggers NCCI bundle denial. CMS bundles LT/RT pairs; use 50 instead.
Documentation requirements
What needs to live in the encounter note for these codes to survive a payer audit.
- Date, time, and specific ear(s) tested (bilateral, left, right, monaural, or binaural) to justify modifier 50 or separate bilateral lines and defend against unbundling audits.
- Clinical indication for each test code (new hearing loss complaint, baseline screening, follow-up monitoring, specific frequency band concern) to support distinct service coding and defeat bundling denials.
- Actual threshold values or waveform findings (air/bone gap in dB, tympanogram type, reflex present/absent) to prove test was completed and not just ordered, protecting against '0 RVU' code denials.
- Audiologist credentials and license number on report to establish professional component for interpretation; required by Medicare LCD and most commercial plans, especially for 92584, 92588.
- Separate physician/audiologist signature per test if multiple codes billed same day to prove distinct clinical decision-making and justify absence of bundle assumption.
- Prior testing results or imaging (if ear canal obstruction, OME, or retrocochlear suspected) referenced in note to justify comprehensive test (92557) over screening (92551) and document medical necessity for payer appeal.
OIG and audit triggers in Audiology
Patterns that show up in OIG Work Plans, RAC audits, and CERT improper payment reviews. Build internal compliance checks around these.
RAC pattern: Unbundling 92550 (tympanometry + reflex, 0.35 RVU) with 92568 (reflex alone, 0.29 RVU) same day without modifier 59 or separate clinical notes. RACs recover $800–2,000 per record in recoupment. Defense: separate reflex protocol with distinct abnormal finding and separate signature by audiologist.
OIG Work Plan audits: Billing 92557 (comprehensive, 0.6 RVU) and 92556 (speech complete, 0 RVU) on same date when 92557 inherently includes speech. Finder: 15% error rate in sample audiology claims. Defense: detailed test protocol showing speech-only retest for specific disorder (e.g., word recognition drop in retrocochlear disease) with separate threshold and discrimination scores.
Commercial payer denial pattern: Modifier 50 misapplied to unilateral-only tests (92551-50, 92552-50) or bilateral modifier used when chart shows only left ear tested. Payer systems auto-deny as impossible. Defense: clear chart documentation 'bilateral ears tested' with thresholds for both ears recorded.
Medicare LCD interpretation: Some MACs enforce coverage policy that 92584 (electrocochleography, 0.98 RVU) is covered only with concurrent ABR (92588) and specific diagnosis (Meniere, SNHL with retrocochlear suspicion). Bundles 92584 into 92588 if no separate clinical question. Defense: prior MRI or imaging results showing no retrocochlear pathology and electrochemical testing distinct from neural pathway assessment per published audiologic literature.
Payer-specific billing notes
Where the major payers diverge from generic Medicare rules in Audiology.
ME Medicare +
CMS does not publish NCD for audiology; coverage is MAC-driven by regional LCD. Palmetto GBA (regions J, M) and Novitas (regions F, K, L) frequently issue LCD denials for 92584 without concurrent 92588 or imaging evidence of retrocochlear disease. Prior authorization not mandated nationally but recommended for 92584, 92588, 92579. 2026 RVU changes: CMS proposed 92557 bump from 0.6 to 0.65 RVU; confirm final rule. No significant changes to bundling rules expected.
UN UnitedHealthcare +
UHC Optum delegates audiology authorization to payer medical management. Requires prior auth for any test beyond 92551/92552 (screening). 92557 (comprehensive) pre-approval required; denial rate 8% if documentation lacks 'abnormal finding on screening.' UHC bundles 92567 + 92568 unless modifier 59-XS with separate clinical indication documented. No modifier 50 adjustment; bilateral tests billed with LT/RT modifiers and reimbursed at 100% per side (not 150%).
AN Anthem +
Anthem ICR (imaging, cardiology, radiology) does not control audiology; medical policy review conducted in-house. Anthem bundles 92550 and 92568 automatically; unbundling requires medical review and supporting documentation of rare/pathologic reflex pattern justifying separate 92568. Comprehensive test (92557) requires baseline or abnormal previous screening for medical necessity; Anthem denies screening-to-comprehensive upgrades without prior finding. Modifier 25 accepted for E/M + audiology same day.
CI Cigna +
Cigna does not delegate audiology to eviCore (radiology/oncology only). Cigna medical policy covers 92551 screening without restriction but requires diagnosis code H90.x or R41.842 for any advanced testing (92557, 92570, 92588). Bilateral modifier 50 accepted but capped at 150% (not 200%) reimbursement. Electrocochleography (92584) considered investigational in some Cigna plans; appeal required with published literature supporting medical necessity for Meniere or retrocochlear differential.
Standard Audiology coding workflow
Step 1: Chart review—identify chief complaint (hearing loss, tinnitus, vertigo, otalgia) and document specific ear(s) involved (unilateral vs bilateral). Step 2: Determine test complexity—screening (92551) vs extended (92552) vs comprehensive (92557) based on frequency range tested and need for bone conduction. Step 3: Add ancillary tests in sequence (immittance 92570, reflex 92568, speech 92556) only if clinically distinct from primary test. Step 4: Assign modifiers—use 50 for bilateral identical tests, 25 for separate E/M, 59-XS only for separate anatomic structures. Step 5: Audit bundling pairs (92550 vs 92567, 92557 vs 92556) against note content; do not code both unless distinct clinical questions documented.
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Verified against the CMS 2026 code set on May 31, 2026.
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