Summary & Overview
CPT 92622: Diagnostic Analysis of Auditory Osseointegrated Sound Processor
CPT code 92622 represents the diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor for the initial 60 minutes. This service is a cornerstone in the management of hearing loss, providing patients with tailored auditory solutions through advanced technology. The code is widely recognized across major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, ensuring broad coverage for individuals requiring these specialized services.
This publication offers a comprehensive overview of CPT 92622, detailing its clinical significance, payer coverage, and the typical office-based setting where the service is delivered. Readers will gain insights into relevant benchmarks, policy updates, and the clinical context surrounding the use of osseointegrated sound processors. The article also highlights associated billing practices, including common modifiers and related codes, as well as the range of clinical diagnoses that may necessitate this procedure. By understanding the scope and application of CPT 92622, stakeholders can better navigate the evolving landscape of auditory rehabilitation services.
CPT Code Overview
CPT 92622 is used for the diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type, for the first 60 minutes. This procedure falls under Evaluative and Therapeutic Otorhinolaryngologic Services and is typically performed in an office setting (Place of Service 11). The code is essential for ensuring that patients with hearing loss receive accurate assessment and programming of their osseointegrated sound processors, which are critical for auditory rehabilitation.
Clinical & Coding Specifications
Clinical Context
A patient with hearing loss, such as sensorineural hearing loss or central auditory processing disorder, presents to an audiology office for evaluation and management of their auditory osseointegrated sound processor. The audiologist conducts a diagnostic analysis, programming, and verification of the device to ensure optimal auditory function. This process typically takes up to 60 minutes and may involve device adjustments, patient counseling, and verification of hearing improvement. The service is performed in an office setting and is commonly provided by audiologists or audiologist-hearing aid fitters.
Coding Specifications
- Modifier
AB: Used to indicate a distinct procedural service, as per CMS guidance. This modifier is applied when the procedure is separate and distinct from other services provided on the same day.
| Taxonomy Code | Specialty Name |
|---|---|
231H00000X | Audiologist |
237600000X | Audiologist-Hearing Aid Fitter |
231HA2400X | Audiologist-Hearing Aid Fitter |
- Audiologist: Specializes in the evaluation and management of hearing disorders.
- Audiologist-Hearing Aid Fitter: Specializes in fitting and managing hearing aids and related devices.
Related Diagnoses
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H91.90: Unspecified hearing loss, unspecified ear- Relevant for patients with hearing loss where the specific type or ear is not documented, often requiring device evaluation.
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H90.3: Sensorineural hearing loss, bilateral- Indicates bilateral sensorineural hearing loss, a common indication for osseointegrated sound processor fitting and programming.
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H93.25: Central auditory processing disorder- Used for patients with central auditory processing issues, which may benefit from device programming and verification.
-
H91.8X9: Other specified hearing loss, unspecified ear- Covers other types of hearing loss not otherwise specified, relevant for device management.
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Z01.10: Encounter for examination of ears and hearing without abnormal findings- Used for routine examination and device verification when no abnormal findings are present.
Related CPT Codes
92623: Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; each additional 15 minutes (List separately in addition to code for primary procedure)
92623 is used in conjunction with 92622 when the diagnostic analysis, programming, and verification of the auditory osseointegrated sound processor requires more than the initial 60 minutes. It is not used as a stand-alone code but as an add-on for additional time spent beyond the primary procedure.
National Reimbursement Benchmarks
National mean rates for CPT code 92622 show that UnitedHealth Group and Cigna offer the highest average reimbursement, with UnitedHealth Group at $130.73 and Cigna at $120.89. In contrast, Medicare's mean rate is $80.28, which is significantly lower than the BUCA (Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna) commercial average of $101.98.
Rate dispersion varies notably across payers. Medicare has the tightest range between the 25th and 75th percentiles ($6.00), indicating minimal variation in rates. UnitedHealth Group displays the widest spread ($75.33), followed by Cigna ($63.75), suggesting greater variability in commercial reimbursement. Aetna and Blue Cross Blue Shield have moderate dispersion, with ranges of $21.75 and $44.50, respectively.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
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