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The evaluation of auditory function for surgically implanted device candidacy or postoperative status is a critical process that assesses whether a patient qualifies for devices such as cochlear implants. This evaluation is particularly important for individuals with significant hearing disabilities who may not benefit from traditional hearing aids. The procedure begins with a comprehensive case history that explores various factors contributing to the patient's hearing loss. This includes inquiries about recent changes in the ability to understand speech, any family history of hearing loss, and the current use of hearing aids. The provider evaluates the functional integrity of the existing hearing aid, assessing its effectiveness and any improvements that may have been achieved through adjustments or optimizations. During the evaluation, the patient is placed in a controlled sound booth, where loudspeakers are strategically positioned to create a spherical coordinate system around the patient. This setup allows for precise control over the sound presentation and intensity levels. The assessment involves testing the patient's ability to perceive speech and understand both words and sentences in a quiet environment, with varying intensity levels from different loudspeaker locations. Additionally, the testing is repeated in the presence of background noise to gauge the patient's auditory performance under more challenging conditions. The results of these tests are quantified separately for each ear, both with and without the amplification device, and are also assessed binaurally. Standard performance measures are utilized to interpret the results, which ultimately help determine the potential success of an implant. Furthermore, similar evaluations may be conducted postoperatively to monitor auditory function after the surgical placement of the device. For billing purposes, the initial hour of evaluation is reported using CPT® code 92626, while each additional 15 minutes of evaluation is reported with CPT® code 92627.
© Copyright 2026 Coding Ahead. All rights reserved.
The evaluation of auditory function for surgically implanted device candidacy or postoperative status is indicated for patients who exhibit significant hearing loss and may benefit from surgical intervention. The specific indications include:
The procedure for evaluating auditory function involves several detailed steps to ensure a comprehensive assessment of the patient's hearing capabilities. The following procedural steps are undertaken:
After the evaluation, the patient may receive recommendations based on the results of the auditory function tests. If the patient is deemed a suitable candidate for a cochlear implant, further discussions regarding the surgical procedure and postoperative care will take place. Postoperative evaluations may also be scheduled to monitor the patient's auditory function after the implant has been placed, ensuring that the device is functioning correctly and that the patient is achieving optimal auditory outcomes. Continuous follow-up assessments may be necessary to adjust the device settings and provide additional support as needed.
| Short Descr | EVAL AUD FUNCJ EA ADDL 15 | Medium Descr | EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15 | Long Descr | Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); each additional 15 minutes (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures 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 | Items and Services Packaged into APC Rates | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | T2D - Other tests - other | MUE | 6 | CCS Clinical Classification | 25 - Diagnostic procedures on ear |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 92626 | Telehealth Service (Medicare) MPFS Status: Active Code APC Q1 Physician Quality Reporting PUB 100 CPT Assistant Article Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); first hour |
| 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 | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | GW | Service not related to the hospice patient's terminal condition | GX | Notice of liability issued, voluntary under payer policy | 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 | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2024-01-01 | Changed | Guidelines added |
| 2020-01-01 | Changed | Code description changed. |
| 2006-01-01 | Added | First appearance in code book in 2006. |
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