Summary & Overview
CPT 92616: Evaluation of Auditory Rehabilitation Status, First Hour
CPT code 92616 represents the evaluation of auditory rehabilitation status for the first hour, a critical service in audiology that supports patients with hearing loss in their ongoing rehabilitation. This code is widely recognized across major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, ensuring broad coverage for patients seeking auditory rehabilitation services.
The publication provides a comprehensive overview of 92616, detailing its clinical context, typical site of service, and its role in the continuum of audiology care. Readers will gain insight into payer coverage, relevant modifiers such as 52 for reduced services and 59 for distinct procedural service, and associated provider taxonomies. The summary also highlights common ICD-10 diagnoses linked to this code, such as sensorineural hearing loss and unspecified hearing loss, as well as related CPT codes that may be used in conjunction with 92616.
Key benchmarks and policy updates are discussed, offering clarity on how this code fits within national billing practices and clinical workflows. The article is designed to inform healthcare professionals, billing specialists, and policy analysts about the essential aspects of 92616 and its significance in supporting auditory rehabilitation for patients across the United States.
CPT Code Overview
CPT code 92616 is used to report the evaluation of auditory rehabilitation status for the first hour. This procedure is performed by audiology professionals to assess a patient's progress and needs in auditory rehabilitation, which may include evaluating hearing aid effectiveness, communication strategies, and overall auditory function. The typical site of service for this evaluation is an office setting (Place of Service 11). This code is essential for tracking and billing comprehensive audiology services related to auditory rehabilitation.
Clinical & Coding Specifications
Clinical Context
A patient with bilateral sensorineural hearing loss presents to an audiology office for evaluation of their auditory rehabilitation status. The audiologist assesses the patient's progress with hearing aids or other auditory rehabilitation interventions over the course of the first hour. The clinical workflow includes reviewing the patient's hearing history, current rehabilitation strategies, and measuring outcomes to determine effectiveness and next steps in their auditory rehabilitation plan.
Coding Specifications
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Modifier
52(Reduced Services): Used when the evaluation of auditory rehabilitation status is performed but not to the full extent typically required (e.g., less than a full hour). -
Modifier
59(Distinct Procedural Service): Used when the evaluation is performed as a distinct service from other audiology procedures on the same day.
| Provider Taxonomy Code | Specialty Name |
|---|---|
231H00000X | Audiologist |
231HA2400X | Audiologist-Hearing Aid Fitter |
231H00000X | Audiologist-Hearing Aid Fitter |
Related Diagnoses
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H90.3- Sensorineural hearing loss, bilateral- Indicates bilateral sensorineural hearing loss, which is a primary reason for auditory rehabilitation evaluation.
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H91.90- Unspecified hearing loss, unspecified ear- Used when hearing loss is present but the specific ear or type is not documented.
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H91.91- Unspecified hearing loss, right ear- Indicates hearing loss in the right ear without further specification.
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H91.92- Unspecified hearing loss, left ear- Indicates hearing loss in the left ear without further specification.
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H91.93- Unspecified hearing loss, bilateral- Used for bilateral hearing loss when the type is not specified.
Each diagnosis code is clinically relevant as they represent the types of hearing loss that may necessitate an evaluation of auditory rehabilitation status using 92616.
Related CPT Codes
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92557- Comprehensive audiometry threshold evaluation and speech recognition- Often performed prior to or in conjunction with
92616to assess baseline hearing and speech recognition abilities.
- Often performed prior to or in conjunction with
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92567- Tympanometry (impedance testing)- Used to evaluate middle ear function, which may be relevant in the overall assessment of hearing loss.
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92568- Acoustic reflex testing; threshold- Assesses the integrity of the auditory pathway and may be used alongside
92616for a comprehensive evaluation.
- Assesses the integrity of the auditory pathway and may be used alongside
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92570- Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing- Provides a broader assessment of auditory function and may be used in combination with
92616for a complete audiological evaluation.
- Provides a broader assessment of auditory function and may be used in combination with
These codes are commonly used together in audiology workflows to provide a thorough assessment of hearing and auditory rehabilitation status.
National Reimbursement Benchmarks
National mean rates for CPT code 92616 show that Medicare reimburses at $238.10, while the average commercial benchmark (BUCA) is slightly lower at $222.61. UnitedHealth Group offers the highest mean rate among major payers at $290.82, with Cigna also above Medicare at $267.71. Aetna's mean rate is the lowest at $148.55.
Rate dispersion varies significantly across payers. Medicare has the tightest range between the 25th and 75th percentiles ($27.00), indicating more consistent reimbursement. In contrast, UnitedHealth Group exhibits the widest spread ($152.93), followed by Cigna ($137.00), 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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