CPT® Code 92565

Official Description

Stenger test, pure tone

Common Language Description

The Stenger test, identified by CPT® Code 92565, is a specialized auditory assessment utilized to evaluate hearing capabilities through pure tone audiometry. This test is conducted using earphones, allowing for a controlled environment where each ear is tested both separately and in conjunction. The primary objective of the Stenger test is to ascertain the hearing threshold for each ear, which is the minimum sound level at which a patient can detect a tone. During the procedure, a tone is presented at the determined hearing threshold to each ear individually. The patient is then prompted to indicate whether they perceive the tone in the right or left ear. In individuals with normal hearing or those experiencing functional hearing loss, the expected response is that a tone delivered to the right ear will be heard in that ear, and similarly for the left ear. When tones are delivered simultaneously to both ears at the hearing threshold, the sound is typically perceived centrally, provided that the sensitivity levels of both ears are equal. However, if there is a disparity in sensitivity levels, the sound will be perceived in the ear with the higher sensitivity until the intensity in the less sensitive ear is adjusted to match its hearing threshold. In cases of nonorganic hearing loss, which may be psychogenic or feigned, the results of the Stenger test will deviate from the anticipated pattern. This test is often integrated with other pure tone assessments, and it is designed in such a way that the patient remains unaware that the purpose is to differentiate between functional and nonorganic hearing loss. The outcomes of the Stenger test are documented on an audiogram, accompanied by a written interpretation of the findings to provide a comprehensive overview of the patient's auditory status.

1. Indications

The Stenger test is indicated for use in specific scenarios where there is a need to differentiate between functional hearing loss and nonorganic hearing loss. The following conditions may warrant the performance of this test:

Functional Hearing Loss Patients who exhibit hearing loss that does not correlate with organic causes, often referred to as functional hearing loss, may be evaluated using the Stenger test to assess the validity of their hearing capabilities.
Nonorganic Hearing Loss Individuals suspected of having nonorganic hearing loss, which may be psychogenic or feigned, are prime candidates for this test to determine the authenticity of their reported hearing difficulties.
Assessment of Hearing Thresholds The test is also indicated for patients requiring a thorough assessment of their hearing thresholds in both ears, particularly when discrepancies in hearing sensitivity are noted.

2. Procedure

The Stenger test is conducted through a series of methodical steps to ensure accurate assessment of auditory function. The procedure begins with the patient being fitted with earphones, which are essential for delivering pure tone stimuli to each ear. The audiologist first determines the hearing threshold for each ear separately. This involves presenting tones at varying intensities until the patient indicates they can hear the sound. Once the thresholds are established, a tone is delivered to the right ear at the identified hearing threshold. The patient is then asked to report whether they can hear the tone in the right or left ear. Following this, a similar tone is presented to the left ear at its respective hearing threshold. The audiologist observes the patient's responses closely. In cases where both tones are presented simultaneously, the expected outcome is that the sound will be perceived centrally if the sensitivity levels are equal. However, if there is a difference in sensitivity, the sound will be perceived in the ear with the higher sensitivity level until adjustments are made to equalize the intensity in the less sensitive ear. Throughout the test, the patient remains unaware of the specific purpose of the assessment, which is to discern between functional and nonorganic hearing loss. The results of the Stenger test are meticulously recorded on an audiogram, and a written interpretation of the findings is subsequently provided to summarize the outcomes of the evaluation.

3. Post-Procedure

After the completion of the Stenger test, the audiologist will review the results with the patient, providing a detailed interpretation of the audiogram. It is essential to discuss the implications of the findings, particularly if nonorganic hearing loss is suspected. The patient may be advised on further evaluations or referrals to specialists if necessary. Additionally, the audiologist may recommend follow-up appointments to monitor the patient's hearing status or to conduct further testing if discrepancies in hearing ability are noted. Proper documentation of the test results and interpretations is crucial for ongoing patient care and for any potential insurance claims related to the assessment.

Short Descr	STENGER TEST PURE TONE
Medium Descr	STENGER TEST PURE TONE
Long Descr	Stenger test, pure tone
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	3 - Technical Component Only Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	2 - 150% payment adjustment does NOT apply.
Physician Supervisions	02 - Procedure must be performed under the direct supervision of a physician.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	STV-Packaged Codes
Type of Service (TOS)	K - Hearing Items and Services
Berenson-Eggers TOS (BETOS)	T2D - Other tests - other
MUE	1
CCS Clinical Classification	220 - Ophthalmologic and otologic diagnosis and treatment

59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
AB	Audiology service furnished personally by an audiologist without a physician/npp order for non-acute hearing assessment unrelated to disequilibrium, or hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids; service may be performed once every 12 months, per beneficiary
GA	Waiver of liability statement issued as required by payer policy, individual case
GY	Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
GZ	Item or service expected to be denied as not reasonable and necessary
KX	Requirements specified in the medical policy have been met
XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service