Summary & Overview
CPT 92620: Evaluation of Central Auditory Function, Initial 60 Minutes
CPT code 92620 represents the evaluation of central auditory function, including a detailed report, for the initial 60 minutes. This procedure is a cornerstone in the assessment of auditory processing disorders and related conditions, supporting accurate diagnosis and treatment planning. 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 specialized auditory evaluation.
The publication provides a comprehensive overview of 92620, detailing its clinical context, typical site of service, and its role within evaluative and therapeutic otorhinolaryngologic services. Readers will gain insight into payer coverage, relevant benchmarks, and recent policy updates affecting reimbursement and utilization. The summary also highlights associated ICD-10 diagnoses and related CPT codes, offering a clear understanding of how 92620 fits within broader audiology and otolaryngology practice patterns. This resource is designed for healthcare professionals, administrators, and policy analysts seeking up-to-date information on medical billing and coding for central auditory function evaluation.
CPT Code Overview
CPT code 92620 is used for the evaluation of central auditory function, with a comprehensive report, for the initial 60 minutes. This service falls under Evaluative and Therapeutic Otorhinolaryngologic Services and is typically performed in a diagnostic testing setting, such as an Independent Diagnostic Testing Facility (Place of Service 11). The procedure is designed to assess the central auditory processing abilities of patients, providing critical information for diagnosis and management of auditory disorders.
Clinical & Coding Specifications
Clinical Context
A patient, often a child or adolescent, is referred to an audiologist or otolaryngologist due to concerns about difficulty processing auditory information, despite normal hearing sensitivity. The evaluation is performed in a diagnostic testing setting, such as an Independent Diagnostic Testing Facility (POS 11). The provider conducts a comprehensive assessment of central auditory function over a 60-minute session, utilizing specialized tests to identify disorders like central auditory processing disorder. The results are documented in a detailed report to guide further management or intervention.
Coding Specifications
- Modifier
SM: Statutory bilateral procedure. Used when the evaluation is performed on both ears as required by statute or regulation.
| Modifier Code | Description |
|---|---|
SM | Statutory bilateral procedure |
- Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
207S00000X | Audiology |
206E00000X | Otolaryngology |
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Specialties Represented:
- Audiology: Providers specializing in the assessment and management of hearing and auditory disorders.
- Otolaryngology: Providers specializing in ear, nose, and throat disorders, including auditory function.
Related Diagnoses
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H93.25: Central auditory processing disorder- Directly relevant as the primary diagnosis for patients undergoing central auditory function evaluation.
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H91.90: Unspecified hearing loss, unspecified ear- Used when hearing loss is present but not specifically defined; may prompt further evaluation of central auditory function.
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H93.3: Other abnormal auditory perceptions- Indicates abnormal auditory experiences, which can be investigated through central auditory testing.
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F80.4: Speech and language development delay due to hearing loss- Relevant for pediatric patients whose speech and language delays may be linked to auditory processing issues.
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R48.8: Other symbolic dysfunctions- Used when patients exhibit difficulties with symbolic processing, which may be associated with central auditory disorders.
Related CPT Codes
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92621: Evaluation of central auditory function, with report; each additional 15 minutes (list separately in addition to code for primary procedure)- Used when the evaluation extends beyond the initial 60 minutes covered by
92620. Commonly billed together for extended testing sessions.
- Used when the evaluation extends beyond the initial 60 minutes covered by
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92571: Filtered speech test- A specific test that may be included as part of the central auditory function evaluation. Used to assess auditory processing abilities.
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92572: Staggered spondaic word test- Another specialized test for central auditory processing, often performed during the evaluation.
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92576: Synthetic sentence identification test- Used to evaluate the patient's ability to identify sentences under challenging listening conditions. May be part of the comprehensive assessment.
These codes are frequently used together in a clinical workflow to provide a thorough evaluation of central auditory function. 92621 is an add-on code for extended time, while 92571, 92572, and 92576 represent specific tests that may be performed during the session.
National Reimbursement Benchmarks
Nationally, UnitedHealth Group has the highest mean rate for CPT code 92620 at $148.24, while Medicare's mean rate is the lowest at $91.59. The average commercial mean rate, represented by BUCA, stands at $117.24, which is $25.65 higher than Medicare.
Rate dispersion varies significantly across payers. Medicare shows the tightest range between the 25th and 75th percentiles ($6.00), indicating minimal variation in rates. In contrast, Cigna and UnitedHealth Group exhibit the widest dispersions, with Cigna's range at $90.00 and UnitedHealth Group's at $91.32, reflecting greater variability in commercial reimbursement.
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
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