2025 CPT code 92626
(Active) Effective Date: N/A Revision Date: N/A Evaluation - Evaluative and Therapeutic Otorhinolaryngologic Services Medicine Services and Procedures > Special Otorhinolaryngologic Services and Procedures Feed
Evaluation of auditory function for surgically implanted device candidacy or postoperative status; first hour.
Modifiers 59 (Distinct Procedural Service) or other relevant modifiers may be applied if appropriate. Always review guidelines and local payer policies before using any modifiers.
The medical necessity for this code is established by the need to assess candidacy for or monitor the progress of treatment related to surgically implanted hearing devices. Documentation must support the clinical need and justify the evaluation based on the patient's symptoms and clinical presentation.
Audiologist or other qualified healthcare professional performs the auditory function assessment. This includes evaluating sound awareness, sound differentiation (loud/soft, high/low pitch), general hearing ability, and listening skills in various environments. The clinician then interprets results to advise on candidacy for implantable hearing devices or efficacy of existing devices.
- Medicine Services and Procedures > Special Otorhinolaryngologic Services and Procedures
- Special Otorhinolaryngologic Services and Procedures
In simple words: This code covers a detailed hearing test that helps determine if someone is a good candidate for a surgically implanted hearing device or to check how well a previously implanted device is working. This test takes about one hour.
This CPT code encompasses a comprehensive evaluation of auditory function, performed for either pre-operative assessment of candidacy for surgically implanted hearing devices (such as cochlear implants, middle-ear implants, or osseointegrated implants) or for post-operative monitoring of patients with existing implanted devices. The evaluation assesses various aspects of auditory function, including sound perception, listening ability, orienting movements, and balance.The assessment aims to determine the patient's suitability for a surgical implant or to assess the effectiveness of an already implanted device.This code is specifically for the first hour of the evaluation.
Example 1: Pre-operative evaluation of a 60-year-old patient with significant hearing loss to determine candidacy for a cochlear implant.The evaluation includes detailed audiometric testing, speech perception testing, and assessment of the patient's overall communication skills and lifestyle needs., Post-operative assessment of a 45-year-old patient, six months after receiving a bilateral cochlear implant, to monitor progress, adjust settings, and troubleshoot any issues. The assessment includes assessment of speech perception, sound localization, and overall auditory function., A 72-year-old patient with a bone-anchored hearing aid undergoes an assessment to ensure proper function and fitting, and to adjust the parameters to address any reported changes in hearing. This code would be appropriate for the evaluation.
Detailed audiometric test results, patient history of hearing loss and related conditions, observations on speech perception and sound localization, description of the procedure including start and stop times, and clinician's assessment and recommendations are all essential.
** Accurate documentation of the time spent conducting the evaluation is essential for proper billing. This code is not for routine hearing aid fitting or checks, nor is it for diagnostic programming of cochlear implants.
- Revenue Code: T2D (OTHER TESTS - OTHER)
- RVU: The RVUs for this code vary by location and payer. Consult your specific payer's fee schedule for the most accurate information.
- Global Days: Not applicable. This is an evaluation code, not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable. This is an evaluation code, not a procedure with a technical component.
- Fee Schedule: Historical fee schedules vary significantly based on location and payer. Consult historical payer data for specific fee information.
- Specialties:Audiology, Otolaryngology
- Place of Service:Office, Hospital Outpatient, Ambulatory Surgery Center