2025 CPT code 69799
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Auditory System Surgery Feed
Unlisted procedure on the middle ear.
Modifiers may be applicable depending on the specific procedure and circumstances (e.g., 50 for bilateral procedures, 51 for multiple procedures, etc.).
Medical necessity must be clearly established, demonstrating the procedure was necessary to treat a specific diagnosis and that no other appropriate coded procedure existed.Documentation must support medical necessity according to payer guidelines.
The provider performs a middle ear procedure not represented by any standard, active CPT code.Thorough documentation is essential before billing for this unlisted procedure.
In simple words: This code is used when a doctor performs a procedure on the middle ear that doesn't have its own specific billing code.The doctor must provide detailed information about the procedure to get paid.
This CPT code reports a procedure on the middle ear for which no other specific code exists.The middle ear is the space behind the tympanic membrane in the temporal bone, containing the tympanic cavity, auditory ossicles, and auditory tube.Use this code only when no other specific CPT code accurately describes the procedure performed.Detailed documentation, including comparison to similar codes and operative notes, must accompany the claim for reimbursement consideration.
Example 1: Implantation of an osseointegrated bone-conduction hearing system with magnetic connection and coupling., Repair of an unusual middle ear perforation requiring specialized surgical technique., Removal of a foreign body from the middle ear that requires a complex surgical approach.
* Operative report detailing the procedure performed.* Pre-operative and post-operative diagnoses.* Justification for using unlisted code 69799 versus similar, existing codes.* Detailed description of the procedure performed, including time and resources used.* Any relevant imaging studies.
** Always check with the payer for specific reimbursement policies and requirements for unlisted procedure codes.The information provided here is for guidance only and should not be considered exhaustive.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: RVUs will vary depending on the specific procedure performed and payer.Detailed documentation is crucial for accurate reimbursement.
- Global Days: Global surgical period will depend on the specific procedure;refer to payer guidelines.
- Payment Status: Active
- Modifier TC rule: The applicability of a Technical Component (TC) modifier depends entirely on the specific procedure performed. Refer to payer guidelines and associated procedural information.
- Fee Schedule: Historical fee schedule data varies significantly by payer and location.Consult payer-specific fee schedules for details.
- Specialties:Otolaryngology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center