Healthcare billing requires precision. That’s especially true for audiometric procedures. That’s because audiometric billing involves many details, rules, and billing restrictions. Even small mistakes while submitting claims can lead to denials.
A frequently used ENT billing code is CPT code 92567. In this guide, we will go through the code’s proper application, billing requirements, and reimbursement guidelines. So, let’s start.
CPT Code 92567 – Description
CPT code 92567 describes tympanometry, also known as impedance testing. Tympanometry is a diagnostic ENT procedure that evaluates middle ear function by measuring the compliance and movement of the eardrum (tympanic membrane) and other middle ear structures. During this procedure, the healthcare providers create controlled air pressure of varying power in the ear canal to assess how well the eardrum moves in response to pressure changes.
The provider inserts a small probe into the ear canal. This probe creates varying air pressures and also simultaneously measures the eardrum’s response. Based on the data points, the provider makes a graph called a tympanogram, which displays the relationship between air pressure and eardrum mobility. The reading from this graph helps him identify different ear-related problems.
Although tympanometry is a simple procedure, it is essential for audiological evaluations, particularly valuable for diagnosing fluid accumulation behind the eardrum, eustachian tube dysfunction, ear infections, and other middle ear pathologies.
An important thing to note about CPT code 92567 is that 92567 is a session-based code. This means that it can only be billed once per day, regardless of different tympanometry techniques performed during the same visit. This includes standard tympanometry, multi-frequency tympanometry, and wideband reflectance testing.
Also, like most other auditory codes, 92567 is used to bill for testing both ears, so bilateral or LT/RT modifiers are not required.
Scenarios Where CPT Code 92567 is Applicable
To better understand the usage of CPT code 92567, let’s look at a couple of real-world scenarios in which it is applicable:
Otitis Media Evaluation
Otitis media is an infection or inflammation of the middle ear. ENT specialists often use tympanometry to diagnose acute and chronic otitis media. In this test, physicians identify fluid presence behind the eardrum, which helps distinguish between different types of ear infections and treatment options. So, if a patient needs ear evaluation for otitis media, the physician can use tympanometry under CPT code 92567 for billing.
Pre-Surgical Evaluation
Before ear surgeries, including tympanoplasty or mastoidectomy, surgeons often request tympanometry to establish baseline middle ear function and document pre-operative status. Post-operative follow-up visits may also include tympanometry to monitor healing and functional outcomes.
Applicable Modifiers for CPT Code 92567
You may append the following modifiers to CPT 92567 for coding specificity and to collect accurate reimbursements.
| Modifier | Name | Description & Usage |
|---|---|---|
| 22 | Increased Procedural Services | Used to indicate that the work is substantially greater than typically required. |
| 52 | Reduced Service | This modifier indicates that the service provided was less extensive than usually required for the procedure. For example, it can be used when only one ear is tested. |
| 59 | Distinct Procedural Service | Indicates that tympanometry is distinct from other procedures performed on the same day. |
CPT Code 92567 – Billing & Reimbursement Guidelines
The following billing tips and reimbursement guidelines will help you prevent denials for claims with CPT code 92567 and collect accurate reimbursement for the tympanometry procedure.
Confirm the Medicare Reimbursement Rates
According to the latest Medicare Physician Fee Schedule, the national average reimbursement amount for CPT code 92567 is $15.53 for non-facility settings and $10.35 for facility settings. However, this rate varies significantly based on the Medicare Administrative Contractor (MAC) locality. So, we recommend checking the exact amount for your MAC address on Medicare’s PFS Lookup Tool.
Follow the Session-Based Billing Requirements
CPT 92567 is considered a session-based code, meaning providers can bill it only once per day, regardless of the number of tympanometry variations performed. If both standard tympanometry and advanced techniques like wideband reflectance testing occur on the same date, only one unit of 92567 is billable. However, providers may consider modifier 22 (Increased Procedural Services) when substantially more work is required than typical.
Pay Heed to the Bundling Restrictions
Many billers often make bundling mistakes with CPT code 92567. The Centers for Medicare and Medicaid Services (CMS) has specific bundling rules for middle ear tests, which are also applicable to CPT code 92567. When providers perform both tympanometry (92567) and acoustic reflex testing (92568) on the same day, they must use the bundled code 92550 (tympanometry and reflex threshold measurements) instead of billing the codes separately. Many billers make these mistakes, which leads to claim denials.
Understand Frequency Limitations
Another rule for billing CPT code 92567 is the frequency limitations. Medicare generally allows tympanometry once per visit, with monthly repetition permitted for patients receiving ototoxic medications. If, for some reason, tympanometry is performed more than once, special documentation is required to justify the medical necessity.
Wrapping Up
CPT code 92567 is an essential ENT billing code used for tympanometry (impedance testing) or to test the function of the middle ear. It is a frequently used code with a low reimbursement amount. However, its complexity and billing restrictions cause numerous denials. So, for successfully billing a 92567 claim, attention to detail is vital.
If you are facing frequent claim denials or hurdles in generating revenue, our experts are available to assist you with their best ENT billing services.
