Summary & Overview
CPT 92614: Evaluation of Auditory Rehabilitation Status, Binaural
CPT code 92614 represents the evaluation of auditory rehabilitation status for patients with binaural hearing loss, a critical service in audiology that supports ongoing management and treatment of hearing impairment. This procedure is commonly performed in office settings and is essential for monitoring patient progress and adjusting rehabilitation strategies. Nationally, the code is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, ensuring broad coverage for patients requiring these services.
This publication provides a comprehensive overview of CPT 92614, including payer coverage, clinical context, and related billing codes. Readers will gain insight into the typical clinical scenarios where this code is used, associated diagnoses, and relevant modifiers. The analysis also highlights related CPT codes for audiology services, offering a broader perspective on hearing health evaluations. Policy updates and benchmarks are discussed to inform stakeholders about current trends and requirements in medical billing for auditory rehabilitation. The information is designed to support healthcare professionals, administrators, and policy analysts in understanding the national landscape for this important audiology procedure.
CPT Code Overview
CPT 92614 is used to report the evaluation of auditory rehabilitation status for patients with binaural hearing needs. This code is part of the audiology service line and is typically performed in an office setting (Place of Service 11). The procedure involves assessing the effectiveness and progress of auditory rehabilitation interventions for individuals with hearing loss affecting both ears. This evaluation is essential for guiding ongoing treatment and optimizing patient outcomes in hearing health.
Clinical & Coding Specifications
Clinical Context
A patient with bilateral hearing loss presents to the office for evaluation of their auditory rehabilitation status. The patient may have previously received hearing aids or cochlear implants and is undergoing assessment to determine the effectiveness of their rehabilitation program. The audiologist or otolaryngology physician conducts a binaural evaluation, focusing on both ears, to assess auditory function and progress. This service is typically performed in an office setting and may be part of ongoing management for patients with sensorineural or other types of hearing loss.
Coding Specifications
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Modifier
52(Reduced Services):- Used when the procedure is partially performed or not completed in its entirety. For example, if only a partial evaluation of auditory rehabilitation status is conducted.
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Modifier
59(Distinct Procedural Service):- Used to indicate that the procedure is distinct or independent from other services performed on the same day. For example, if the evaluation is performed separately from other audiology tests.
| Taxonomy Code | Specialty Name |
|---|---|
231H00000X | Audiologist |
237600000X | Audiologist-Hearing Aid Fitter |
207Y00000X | Otolaryngology Physician |
- Audiologist: Licensed specialist in hearing assessment and rehabilitation.
- Audiologist-Hearing Aid Fitter: Specialist focused on fitting and managing hearing aids.
- Otolaryngology Physician: Medical doctor specializing in ear, nose, and throat disorders, including hearing loss.
Related Diagnoses
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H91.90- Unspecified hearing loss, unspecified ear- Used when the patient's hearing loss is present but not specifically classified or localized.
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H90.3- Sensorineural hearing loss, bilateral- Indicates bilateral sensorineural hearing loss, commonly seen in patients requiring auditory rehabilitation.
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H91.8X9- Other specified hearing loss, unspecified ear- Applied when hearing loss is specified but not attributed to a particular ear.
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Z01.10- Encounter for examination of ears and hearing without abnormal findings- Used for routine hearing evaluations where no abnormalities are detected.
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Z01.118- Encounter for examination of ears and hearing with other abnormal findings- Used when the hearing evaluation reveals abnormal findings, supporting the need for rehabilitation assessment.
Each diagnosis code is relevant for patients undergoing evaluation of auditory rehabilitation status, as they represent common clinical scenarios for which 92614 may be performed.
Related CPT Codes
| CPT Code | Description |
|---|---|
92557 | Comprehensive audiometry threshold evaluation and speech recognition |
92567 | Tympanometry (impedance testing) |
92568 | Acoustic reflex testing; threshold |
92570 | Acoustic immittance testing, includes tympanometry, acoustic reflex threshold testing, and acoustic reflex decay testing |
92557is often performed prior to or alongside92614to establish baseline hearing thresholds and speech recognition abilities.92567,92568, and92570are used to assess middle ear function and reflexes, which may inform the auditory rehabilitation process.- These codes may be used together in a comprehensive audiological evaluation, but each represents a distinct component of the assessment.
National Reimbursement Benchmarks
For CPT code 92614, the national mean rate for Medicare is $157.76, while the BUCA (average commercial) mean rate is $150.12. This places Medicare slightly above the commercial average, though UnitedHealth Group and Cigna both report higher mean rates at $198.73 and $180.99, respectively. Blue Cross Blue Shield and Aetna are below both Medicare and BUCA, with mean rates of $139.99 and $99.58.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare shows the tightest range at $17.00, indicating relatively consistent reimbursement. In contrast, UnitedHealth Group exhibits the widest dispersion at $101.33, followed by Cigna at $93.73, reflecting greater variability in commercial rates. The table and chart below present the full breakdown of national benchmarks for each payer.
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