CPT® Code 92651

Official Description

Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report

Common Language Description

Auditory evoked potentials (AEP) are physiological responses that can be measured in response to auditory stimuli, such as acoustic pulses, brief tones, or short bursts of broadband clicks. These responses are essentially voltage fluctuations that occur in the brain following the presentation of sound stimuli. The primary purpose of conducting AEP testing is to assess the neurological function related to hearing and to identify any potential hearing loss. In the context of newborns, a specific screening protocol is utilized, which involves the presentation of sound stimuli to each ear. This screening is reported under CPT® code 92650 and is part of a universal newborn hearing screening initiative. During this screening, data is collected regarding the evoked potential responses, which are analyzed using an automated computer algorithm. The healthcare provider is responsible for monitoring electrode impedance and ensuring the presence or absence of valid responses as dictated by the algorithm, ultimately generating a pass or refer result. CPT® code 92651 is utilized for post-screening or follow-up testing, particularly when a child has been referred for further evaluation. This follow-up testing focuses on determining the auditory brainstem response (ABR) to broadband sound stimuli and is typically performed while the infant is asleep or under anesthesia for children aged 6 months to 7 years. The sound is delivered through an acoustic transducer into the ear canal using earphones or headphones. The resulting waveform response is captured by surface electrodes, which are usually placed on the forehead and earlobes, or alternatively configured on the forehead, nape of the neck, and either the shoulder or cheek. If a response is not detected at moderate to high stimulus levels, a higher stimulus may be presented. Conversely, if a response is easily identified and replicated, the stimulus level may be reduced. The amplitude of the recorded signal is averaged and plotted over time, akin to an EEG recording, and the findings are subsequently interpreted and documented in a written report.

1. Indications

The procedure for auditory evoked potentials (AEP) is indicated for the following conditions:

Hearing Loss AEP testing is performed to assess and determine the presence of hearing loss in patients, particularly in infants and young children who may not be able to communicate their hearing difficulties.
Neurological Assessment The procedure is utilized to evaluate the auditory neurological function, helping to identify any abnormalities in the auditory pathways that may affect hearing.
Follow-Up Testing AEP is indicated for patients who have been referred for further testing after an initial screening, particularly when a pass or refer result has been generated during the universal newborn hearing screening.

2. Procedure

The procedure for auditory evoked potentials (AEP) involves several key steps to ensure accurate assessment of auditory function:

Preparation The patient, typically an infant or young child, is prepared for the test, which may involve ensuring that the child is calm and, if necessary, asleep or under anesthesia. This is crucial for obtaining reliable results, especially in younger patients.
Sound Stimulus Presentation An acoustic transducer is used to deliver broadband sound stimuli into the ear canal through earphones or headphones. The sound stimuli can include acoustic pulses, brief tones, or broadband clicks, designed to elicit a response from the auditory system.
Electrode Placement Surface electrodes are strategically placed on the patient's forehead (vertex of the scalp) and earlobes to measure the brain's electrical responses to the sound stimuli. Alternative configurations may involve placing electrodes on the forehead, nape of the neck (inverting), and either the shoulder or cheek to optimize signal capture.
Response Monitoring The provider monitors the responses to the sound stimuli, checking for electrode impedance and the presence or absence of valid responses. If a response is not observed at moderate to high stimulus levels, a higher stimulus may be presented to elicit a response.
Signal Averaging The amplitude of the elicited waveform response is averaged over time and charted, similar to an EEG recording. This process helps to enhance the clarity of the response and allows for accurate interpretation of the results.
Interpretation and Reporting After the data collection, the recorded responses are interpreted, and a written report of the findings is generated. This report provides essential information regarding the auditory brainstem response and any identified issues related to hearing.

3. Post-Procedure

Post-procedure care for patients undergoing auditory evoked potentials (AEP) testing typically involves monitoring the patient until they are fully awake and alert, especially if anesthesia was used. The results of the AEP test are reviewed and discussed with the patient's caregivers, providing insights into the child's auditory function and any necessary follow-up actions. If hearing loss or other auditory issues are identified, appropriate referrals to specialists or further diagnostic testing may be recommended. Additionally, caregivers are advised on the importance of ongoing hearing assessments and monitoring, particularly in young children, to ensure timely intervention if needed.

Short Descr	AEP HEARING STATUS DETER I&R
Medium Descr	AEP HEARING STATUS DETER BROADBAND STIMULI I&R
Long Descr	Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	0 - Physician Service 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	Procedure or Service, Not Discounted when Multiple
Berenson-Eggers TOS (BETOS)	none
MUE	1

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.
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).
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
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
XE	Separate encounter, a service that is distinct because it occurred during a separate encounter