Summary & Overview
CPT 92625: Auditory Rehabilitation Evaluation with Cochlear Implant Programming
CPT code 92625 covers the evaluation of auditory rehabilitation status with programming and modification of a cochlear implant, excluding diagnostic testing. This procedure is a critical component of ongoing care for individuals with cochlear implants, supporting their auditory health and device performance. Nationally, the code is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, reflecting its widespread clinical and billing relevance.
The publication provides a comprehensive overview of payer coverage, clinical context, and policy benchmarks for CPT code 92625. Readers will gain insight into the typical service setting, associated clinical specialties, and the importance of this code in the continuum of care for hearing-impaired patients. The analysis also highlights related codes and common diagnoses, offering a broader perspective on auditory rehabilitation services. Key policy updates and billing considerations are addressed, equipping stakeholders with the information needed to understand national trends and payer requirements for this specialized otorhinolaryngologic service.
CPT Code Overview
CPT code 92625 is used for the evaluation of auditory rehabilitation status, specifically involving the programming and modification of a cochlear implant, without diagnostic testing. This service falls under Special Otorhinolaryngologic Services and is typically performed in an office setting (Place of Service 11). The procedure is essential for patients with cochlear implants, ensuring optimal device function and auditory outcomes through ongoing assessment and adjustment.
Clinical & Coding Specifications
Clinical Context
A patient with a cochlear implant presents to the office for evaluation of their auditory rehabilitation status. The visit involves programming and modification of the cochlear implant device to optimize hearing function, without performing additional diagnostic testing. The patient may have symptoms such as tinnitus or hearing loss, which are managed through adjustments to the implant. The clinical workflow typically includes reviewing the patient's auditory performance, discussing any changes in symptoms, and making necessary programming modifications to the cochlear implant.
Coding Specifications
-
Modifier
26: Used to indicate the professional component of the service, such as the physician's or audiologist's work in evaluating and programming the cochlear implant. -
Modifier
52: Used when reduced services are provided, such as when only partial programming or modification is performed.
| Modifier Code | Description |
|---|---|
26 | Professional Component |
52 | Reduced Services |
- Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
2084P0800X | Neurology |
2084N0400X | Otolaryngology |
Related Diagnoses
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H93.11- Tinnitus, right ear- Indicates the presence of tinnitus in the right ear, which may be addressed through cochlear implant programming.
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H93.12- Tinnitus, left ear- Indicates tinnitus in the left ear, relevant for patients with cochlear implants experiencing this symptom.
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H93.13- Tinnitus, bilateral- Represents tinnitus in both ears, often seen in patients with bilateral cochlear implants or hearing loss.
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H93.19- Tinnitus, unspecified ear- Used when the affected ear is not specified, applicable in cases where the patient cannot localize the tinnitus.
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H91.90- Unspecified hearing loss, unspecified ear- Denotes hearing loss without specification of the ear, commonly used for patients with cochlear implants when the exact nature of hearing loss is unclear.
Related CPT Codes
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92557- Comprehensive audiometry threshold evaluation and speech recognition- Used to assess hearing thresholds and speech recognition, often performed before or after cochlear implant programming to evaluate auditory function.
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92567- Tympanometry (impedance testing)- Assesses middle ear function, which may be relevant in patients with cochlear implants to rule out other causes of hearing issues.
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92568- Acoustic reflex testing; threshold- Measures the threshold at which the acoustic reflex occurs, providing information about auditory pathway integrity.
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92550- Tympanometry and reflex threshold measurements- Combines tympanometry and acoustic reflex testing, commonly used in comprehensive hearing evaluations.
These codes are often used together in a clinical workflow to provide a complete assessment of auditory function before or after cochlear implant programming. They may also serve as alternatives when different aspects of hearing need to be evaluated.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 92625 is highest among UnitedHealth Group at $112.25, while Medicare's mean rate is $67.98. The BUCA (average commercial) mean rate stands at $89.64, which is notably higher than Medicare.
Rate dispersion varies significantly across payers. Medicare exhibits the tightest range between the 25th and 75th percentiles ($4.00), indicating minimal variation. In contrast, Cigna and UnitedHealth Group show the widest dispersions ($65.50 and $67.92, respectively), reflecting greater variability in rates paid.
The table and chart below present a detailed breakdown of national payer benchmarks for CPT code 92625, including mean rates and percentile values.
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