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National Correct Coding Initiative (CCI) Edits for Audiology Procedures

National Correct Coding Initiative (CCI) Edits for Audiology Procedures

CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The tables below detail CCI edits related to audiology, and have been prepared based on the complete list of edits published on CMS's CCI Web site. The edits contained in the following tables apply to both Medicare Part B and Medicaid services.

The tables below contain the following information:

  • Code pairs that cannot be billed together for the same patient on the same date of service.
  • Code pairs that may be able to be billed together for the same patient on the same date of service by attaching a -59 modifier. The -59 modifier indicates that the procedure is distinct and separate from other services performed on the same date. When applicable, attach modifier -59 to the CPT code listed in column 2. The Academy recommends providers review  CMS’ guidance regarding the use of the -59 modifier to determine if the modifier applies to a particular situation.

Table 1: CCI Edits for Audiology Services

*CPT code 69210, (cerumen management) cannot be billed on the same date of service as any audiometric or vestibular tests.

Column 1
CPT Procedure Code (one)
Column 2
CPT Procedure Code (one)
Can be performed on the same date of service in an office setting? Can be performed on the same date of service in hospital outpatient settings? If can be performed on the same date of service, what modifier should be used?
92540 92270,92541, 92542, 92544, 92545 No No  
92541 92542, 92544, 92545 Yes Yes -59
92542 92544, 92545 Yes Yes -59
92544 92545 Yes Yes -59
92550 92567, 92568 No No  
92553 92552, 92556 No No  
92556 92555 No No  
92557 92552, 92553, 92555, 92556 No No  
92563 92552, 92553 No No  
92568 92567 No No  
92570 92550, 92567, 92568 No No  
92585 92586 No No  
92588 92587 Yes Yes -59
92620 92571, 92572, 92576 No No  
92620 92626 Yes Yes -59
92621 92571, 92572, 92576 No No  
92625 92562 Yes Yes -59
92626 92621 Yes Yes -59
92640 92507, 92508, 92550, 92552, 92553, 92555, 92556, 92557, 92558, 92561-92568, 92570-92572, 92575-92577, 92579, 92582-92588, 92596, 97755 Yes Yes -59

Table 2: CCI for Cochlear Implant Programming

Column 1
CPT Procedure Code (one)
Column 2
CPT Procedure Code (one)
Can be performed on the same date of service in an office setting? Can be performed on the same date of service in hospital outpatient settings? If can be performed on the same date of service, what modifier should be used?
92601 92507, 92508, 92550, 92567, 92568, 92570, 92585, 92586, 92602, 92626 Yes Yes -59
92601 92552-92565, 92571-92584, 92587-92588, 92596-92597, 92603, 92604, 97755 No No  
92602 92507, 92508, 92550, 92567, 92568, 92570, 92585, 92586, 92626 Yes Yes -59
92602 92552-92565, 92571-92584, 92587-92588, 92596-92597, 92604, 97755 No No  
92603 92550, 92567, 92568, 92570, 92585, 92586, 92604, 92626 Yes Yes -59
92603 92552-92565, 92571-92584, 92587-92597, 92602, 97755 No No  
92604 92550, 92567, 92568, 92570, 92626, 92585, 92586 Yes Yes -59
92604 92552-92565, 92571-92584, 92587-92597, 97755 No No  

Also of Interest

Coding

July 07, 2014

Vestibular Testing

June 02, 2014

Screening Services

June 02, 2014

Miscellaneous

June 02, 2014

Modifiers

June 02, 2014