Evaluation of Hearing Impairment - CAM 90102

Description:
Hearing impairment or hearing loss is a reduction in the ability to perceive sound. The loss may range from slight to complete deafness.

Audiometric studies are diagnostic tests that evaluate sensorineural and conductive hearing losses. Conductive hearing loss is the result of disorders of the external or middle ear; sensory hearing loss is secondary to disturbance of the cochlea; neural hearing loss results from disease of the auditory (eighth) nerve or central auditory channel connections. Sensory and neural hearing losses are frequently included under the term sensorineural hearing loss. Mixed or combined hearing loss involves disturbances of both conductive and sensorineural mechanisms. A variety of tests have been designed to evaluate central auditory processing, which is a higher order cortical function that processes auditory information. Therefore, central auditory processing tests do not strictly evaluate hearing impairment, and, thus, are not formally considered in this policy.

The various audiometric tests can be subdivided into standard batteries that are typically used as part of the initial workup of patients presenting with hearing impairment, as well as specialized tests that are typically used in specific clinical situations. The standard batteries vary according to whether the patient is an adult, child or infant. The tests are briefly defined as follows.

Standard Battery of Tests for Adults and Children

1.  Pure-tone audiometry, air and bone conduction
This test is a standard audiometric study that uses tones of various frequencies and intensities as auditory stimuli to measure hearing. As air conduction is the usual method of sound transmission, air audiometry uses the external and middle ear in the transmission of sound to the cochlea and beyond. Bone-conduction audiometry involves the vibration of the skull by direct contact with an oscillating device that is thought to set the cochlear fluids into motion, bypassing the external and middle ear. When bone-conduction thresholds are better than air-conduction thresholds, the hearing loss is conductive. When bone-conduction thresholds are the same as air-conduction thresholds, the hearing loss is sensorineural. When bone-conduction thresholds are reduced but are still better than air conductions, the loss is mixed or combined.

2.  Speech audiometry
This test is a standard audiometric study that measures overall performance in hearing, understanding and responding to speech for a general assessment of hearing and an estimate of degree of practical handicap. It may include a speech recognition test, where the patient repeats words back, and a speech reception threshold, which determines when the patient can first hear speech. It may also be used to reaffirm the findings of the pure-tone audiometry and to diagnose pseudohypacusis (a non-existent or false hearing loss).

3.  Word recognition tests
This category includes filtered speech tests and synthetic sentence identification. These tests specifically assess the patient’s ability to discriminate spoken words.

4.  Acoustic reflex test and acoustic reflex decay
These tests measure the changes in the ear’s ability to conduct sound to the cochlea. Reflexes, called acoustic reflexes, exist and involve middle ear function. Absence of the acoustic reflex may be indicative, among other things, of lesions of the middle ear, acoustic tumor, otosclerosis, facial nerve involvement of the probe ear side and surgical removal or congenital absence of the stapes. These tests may be used in assessing the hearing of neonates and other children too young to cooperate in the audiometric testing of functional hearing loss.

5.  Tympanometry (impedance testing)
This is a standard series of tests to measure the ability of the middle ear to conduct sound. It is particularly useful in the identification of fluid in the middle ear and in the anatomic localization of facial nerve paralysis.

Additional Standard Battery of Tests for Children Only

1.  Select picture audiometry
This test is used to evaluate hearing-impaired children. It involves the use of pictures on cards and the child’s ability to correctly identify objects based on audiologic direction.

2.  Conditioning play audiometry
This is usually performed to test hearing impairment in children 2 to 4 years of age. The child is taught to put an object in a specific place, e.g., a marble in a box or a cow in the barnyard when a specific sound is heard.

Standard Battery of Tests for Infants Only

1.  Auditory evoked potential (also called auditory brainstem response (ABR)
This is an electrophysiologic measure of auditory function that uses responses produced by the auditory nerve and the brainstem and helps differentiate sensory from neural hearing loss. The response is the waveform averaged over many auditory clicks.

It may be helpful in the diagnosis of cerebellopontine angle tumors and acoustic neuromas, is used as a monitor in posterior fossa surgery and may help to establish a hearing threshold for infants and difficult-to-test patients.

2.  Visual reinforcement audiometry (VRA)
The VRA is part of a battery of tests used in the determination of infant hearing loss. The premise of the test is that the rate of patient response is increased by the use of reinforcement.

3.  Evoked otoacoustic emissions (OAE)
Otoacoustic emissions are sounds measured in the external ear canal that are a reflection of the working of the cochlea. Probe and click stimuli are used in the performance of this test. OAE is used in the screening, as well as the diagnosis, of hearing impairment in neonates and young children.

4.  Acoustic reflex test
See Standard Battery of Tests for Adults and Children, Only, No. 4

Specialized Tests for Adults and Children

1.  Auditory Evoked Potential
See Standard tests for infants Only, No. 1

2.  Electrocochleography (ECochG)
This is a measure of the electrical potentials generated in the inner ear as a result of sound stimulation. This test may be used in the evaluation of endolymphatic hydrops or Méniére’s disease.

3.  Tone decay test
This test involves the presentation of a continuous tone to determine whether the threshold for the tone has changed (becomes poorer) over time. The test helps differentiate sensory from neural hearing loss, and is used in the diagnosis of cochlear versus retrocochlear lesions and eighth nerve tumors. While this test is still in use, the auditory evoked potential test is largely used in place of the tone decay test.

4.  Stenger test, pure tone or speech 
This test uses a tone presented simultaneously to both ears and is based on the principle that the tone is perceived only in the ear that receives the greater intensity. It is useful in the diagnosis of pseudohypacusis (hypacusis is a hearing impairment of a conductive or a neurosensory nature, and pseudohypacusis is a non-existent (false) hearing loss.

5.  Sensorineural acuity level (SAL) test
This test measures the extent of sensorineural hearing loss and is also used in the detection of pseudohypacusis among children. It is not a commonly performed test. There are several different tests in use, including one in which a bone-conduction vibrator is placed at the center of the forehead and the threshold shift for a normal ear versus an ear with sensorineural hearing loss is analyzed.

6.  Evoked otoacoustic emissions
While this test is considered part of the standard battery of tests in infants, it is considered a specialized test in adults and children. For a description, see Standard Battery of Tests for Infants Only, No. 3.

Policy:
The grid that follows identifies standard and specialized audiology tests for adults, children and infants. Tests identified as part of the standard battery may be considered MEDICALLY NECESSARY as part of the initial workup of a patient with hearing impairment in the corresponding age group.


Tests identified as specialized would not be part of the initial workup of patients presenting with hearing impairment but may be considered MEDICALLY NECESSARY when initial diagnostic tests are inconclusive.
 
   Adult   Child

 Infant

Standard 
Battery  

Pure-Tone Audiometry

  • Air conduction
  • Bone conduction
  • Masking (if air-bone gap is present)

Speech Audiometry

  • Speech recognition thresholds (SRT)
  • Word recognition (WR) ability

Basic Immittance Test Battery

  • Tympanometry
  • Acoustic reflex measurement  

Same as adult, age dependent

  • Pure Tone Audiometry
  • Speech Audiometry
  • Basic Immittance

Select Picture Audiometry

Conditioning Play Audiometry  

Auditory Evoked Potentials or Auditory Brainstem Response (ABR)

Visual Reinforcement Audiometry (VRA)

Evoked Otoacoustic Emissions (OAE)

Acoustic Reflex Measurement

Specialized Tests

Auditory Evoked Potentials or
Auditory Brainstem Response (ABR)

  • Difficult-to-test patients
  • Neurotologic assessment
  • Retrocochlear pathology (e.g., acoustic neuromas or other lesions)

Electrocochleography (ECochG)

  • Diagnosis of endolymphatic hydropstone
Same as adult
  • ABR
  • ECochG
  • Tone Decay
  • Stenger Test

Evoked Otoacoustic Emissions (OAE)

 
 

 Tone Decay Test

  • Diagnosis of cochlear vs. retrocochlear (tone decay has been largely replaced by ABR but is still in use)

Stenger Test, pure tone or speech

  • Diagnosis of pseudohypacusis

 Sensorineural Acuity Level (SAL)

  • Diagnosis of pseudohypacusis  

 

Obsolete Audiometric Tests:

The following audiometric tests are considered obsolete and thus are considered NOT MEDICALLY NECESSARY:

  • Lombard test (replaced by the Stenger test and auditory evoked potential)
  • Alternate binaural loudness balance test
  • Short increment sensitivity test (replaced by pure tone audiometry, auditory evoked potential)
  • Bekesy audiometry

Investigational Audiometric Tests:*
 
The following audiometric tests are considered INVESTIGATIONAL:

  • Staggered spondaic word test
  • Synthetic sentence identification test

Policy  Guidelines:
Audiometric studies may be medically necessary in illnesses or injuries including, but not limited to, the following:

  • Hearing loss
  • Otitis media
  • Méniére’s disease
  • Labyrinthitis
  • Vertigo (dizziness)
  • Tinnitus
  • Cochlear otosclerosis
  • Neoplasms of the auditory or central nervous system
  • Congenital anomalies
  • Surgery involving the auditory and/or central nervous system, e.g., skull-based tumors such as acoustic neuroma and meningioma
  • Facial nerve paralysis (Bell’s palsy)
  • Bacterial meningitis
  • Exposure to intense noise
  • Ototoxic drugs
  • Fractures of the temporal bone or trauma affecting the central auditory pathways

Audiometric studies using calibrated electronic equipment are technical service codes and only payable in a place of service office, skilled nursing home, nursing facilities, state or local health clinic, community hearing and speech centers and independent clinics. The ONLY exception for payment in an inpatient hospital or outpatient hospital setting are those audiometric studies that CMS recognizes separate payment of a professional component (modifier 26).  

Benefit Application
BlueCard/National Account Issues
Contract or benefit restrictions or exclusions for preventive services may apply to audiometric screening tests. However, many states have mandated universal newborn screening for hearing impairment.

For adult patients, many contracts do not provide benefits for hearing aids, the prescription or fitting of hearing aids or for testing for this purpose. Some Plans do not provide benefits for services related to hearing impairment/loss in the standard contracts but offer riders to cover these services.

Benefits are typically provided for medically necessary hearing tests and the prescription of hearing aids by audiologists or physicians, but these benefits may not apply to sellers of hearing aids who are not qualified providers.

Rationale
The tests of hearing impairment listed in the policy here are considered standard tests of hearing impairment and, thus, the specific diagnostic parameters of each of these tests will not be considered further. In 2000, the American Academy of Pediatrics, as a participant in the Joint Committee on Infant Hearing, published a position statement regarding early hearing detection.1 This statement recommended that all infants have access to hearing screening using a physiologic measure, with the goal that all infants who do not pass the birth admission screen and any subsequent rescreening begin appropriate audiologic and medical evaluations to confirm the presence of hearing loss before 3 months of age. The position statement noted that otoacoustic emission (OAEs) or auditory brainstem response (ABR) are physiologic techniques that have been successfully used for newborn screening. For example, hospitals may screen with otoacoustic emissions technology or auditory brainstem response technology and retest infants who "refer" with the same or other technology.

Central Auditory Processing
When this policy was first issued in 1997, tests of central auditory processing (CAP) were considered investigational. These tests are no longer formally considered in the policy statement, since tests of central auditory processing are not tests of hearing impairment, per se, but tests of how auditory information is processed by the brain. For example, central auditory processes are responsible for sound localization and lateralization, auditory discrimination, auditory pattern recognition and temporal aspects of audition. Tests of CAP are commonly recommended for children with dyslexia, attention deficit disorder or other learning or behavioral disabilities.2 The results of the test may be used to tailor specific teaching or behavioral strategies, and, thus, depending on the contract or benefit design may be considered part of the mental health benefits, or contractually excluded as an evaluation of a learning disability.

An overview of the literature reveals numerous articles describing various tests of central auditory processing. It would appear that the concept of such testing is widely accepted among the medical and audiology community. This acceptance challenges the determination that tests of CAP would still be considered investigational; however, an evidence-based approach to their evaluation is limited due to the multiple different batteries of tests that have been explored,3,4 the lack of a gold standard test for comparison, the heterogeneous nature of patients that have been tested (based both on age and symptoms) and the uncertain impact on the overall health of the patient. In 1996, the American Speech Language Hearing Association published a task force report on CAP and noted that there was persistent controversy over CAP and its disorders and how it should be defined, identified and ameliorated through intervention.5 These same concerns were echoed in a subsequent 2002 consensus report.6

2005 Update
A literature search based on the MEDLINE database for the period of 2004 through June 2005 did not identify additional articles that would prompt reconsideration of the policy statement, which remains unchanged. No further review is scheduled.

References:

  1. American Academy of Pediatrics. Year 2000 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics 2000; 106(4):798-817.
  2. Bamiou DE, Musiek FE, Luxon LM. Aetiology and clinical presentations of auditory processing disorders – a review. Arch Dis Child 2001; 85(5):361-5.
  3. Amos NE, Humes LE. SCAN test-retest reliability for first and third grade children. J Speech Lang Hear Res 1998; 41(4):834-45.
  4. Domitz DM, Schow RL. A new CAPD battery – multiple processing assessment: factor analysis and comparisons with SCAN. Am J Audiol 2000; 9(2):101-11.
  5. Task Force on Central Auditory Processing Consensus Development. American Speech-Language-Hearing Association. Central auditory processing: Current status of research and implications for clinical practice. Am J Audiol 1996; 5:41-54.
  6. Jerger J, Musiek F. Report of the Consensus Conference on the Diagnosis of Auditory Processing Disorders in School-Aged Children. J Am Acad Audiol 2000; 11(9):467-74.

Coding Section

Codes Number  Description 
 CPT 92552  Pure-tone audiometry (threshold); air only 
  92553 Pure-tone audiometry (threshold); air and bone
  92555-92565 Speech audiometry threshold code range
  92563 Tone decay test
  92565 Stenger test, pure tone
  92567 Tympanometry (impedance testing)
  92568 Acoustic reflex testing
  92569 Acoustic reflex decay test
  92571 Filtered speech test
  92575 Sensorineural acuity level test
  92577 Stenger test, speech
  92579 Visual reinforcement audiometry (VRA)
  92582 Conditioning play audiometry
  92583 Select picture audiometry
  92584 Electrochochleography
  92585-92586 Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system code range 
  92587-92588 Evoked otoacoustic emissions code range
  92650

Auditory evoked potentials; Screening of Auditory potential with broadbrand stimuli, automated analysis

  92651

Auditory evoked potentials; For hearing status determination, broadbrand stimuli, with interpretation and report

  92652

Auditory evoked potentials; For threshold estimation at multiple frequencies, with interpretation and report

  92653

Auditory evoked potentials; Neurodiagnostic, with interpretation and report

 ICD-9 Procedure 20.31 Electrocochleography
  95.41 Audiometry (includes acoustic reflex tests, pure-tone audiometry, tympanometry)
  95.42 Clinical test of hearing (includes filtered speech test)
  95.43 Audiological evaluation (includes evoked otoacoustic emissions)
  95.46 Other auditory and vestifular function tests (includes visual reinforcement audiometry)
  95.47 Hearing examination, not otherwise specified (includes brainstem auditory evoked potentials, conditioning play audiometry, select picture audiometry, sensorineural acuity level test, speech audiometry, Stenger test, synthetic sentence identification test, tone decay test, central auditory function tests, staggered spondaic worked test)
 ICD-9 Diagnosis 191.6 Malignant neoplasm of cerebellum, not otherwise specified 
  192.3  Spinal meninges 
  198.3  Secondary neoplasm of brain and spinal cord 
  198.4  Secondary malignant neoplasm of other parts of nervous system (includes meninges) 
  225.0  Benign neoplasm of brain 
  225.1  Benign neoplasm of cranial nerves (includes acoustic neuroma) 
  225.4  Benign neoplasm of spinal meninges 
  237.5  Neoplasm of uncertain behavior of brain and spinal cord 
  237.6  Neoplasm of uncertain behavior of meninges 
  239.6 Neoplasm of unspecified nature, brain 
  239.7 Neoplasm of unspecified nature, endocrine glands, and other parts of nervous system 
  320.81  Anaerobic meningitis 
  320.82  Meningitis due to Gram-negative bacteria, not elsewhere classified 
  320.9  Meningitis due to unspecified bacterium 
  351.0  Bell's palsy 
  382.9  Unspecified otitis media 
  386.00-386.04  Meniere's disease code range 
  386.30-386.35  Labyrinthitis code range 
  387.2  Cochlear otosclerosis 
  388.30-388.32  Tinnitus code range 
  388.5  Disorders of acoustic nerve (includes lesions of acoustic/eighth nerve) 
  389.00-389-08  Conductive hearing loss, code range 
  389.10-389.18  Sensorineural hearing loss code range 
  744.04  Anomalies of ear ossicles (includes absence of stapes) 
  767.5  Facial nerve palsy 
  780.4  Dizziness and giddiness (includes vertigo) 
  801.00-801.99  Fracture of base of skull code range (includes temporal bone) 
  951.5  Injury to acoustic nerve (includes auditory nerve) 
HCPCS    No codes 
ICD-10-CM (effective 10/01/15)  C716  Malignant neoplasm of cerebellum 
  C701  Malignant neoplasm of spinal meninges 
  C7931  Secondary malignant neoplasm of brain 
  C7932  Secondary malignant neoplasm of cerebral meninges 
  C7949  Secondary malignant neoplasm of other parts of nervous system 
  D332  Benign neoplasm of brain, unspecified 
  D321  Benign neoplasm of spinal meninges 
  D432  Neoplasm of uncertain behavior of brain, unspecified 
 

D434 

Neoplasm of uncertain behavior of spinal cord 
  D420  Neoplasm of uncertain behavior of cerebral meninges 
  D421  Neoplasm of uncertain behavior of spinal meninges 
  D429  Neoplasm of uncertain behavior of meninges, unspecified 
  D496  Neoplasm of unspecified behavior of brain 
  D497  Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system 
  G008  Other bacterial meningitis 
  G009  Bacterial meningitis, unspecified 
  G042  Bacterial meningoencephalitis and meningomyelitis, not elsewhere classified 
  G510  Bell's palsy 
  H6690  Otitis media, unspecified, unspecified ear 
  H8109  Meniere's disease, unspecified ear 
  H8309  Labyrinthitis, unspecified ear 
  H8023  Cochlear otosclerosis, bilateral 
  H9319  Tinnitus, unspecified ear 
  H933X9  Disorders of unspecified acoustic nerve 
  H902  Conductive hearing loss, unspecified 
  H9011  Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side 
  H9012  Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side 
  H900  Conductive hearing loss, bilateral 
  H905 Unspecified sensorineural hearing loss 
  H903  Sensorineural hearing loss, bilateral 
  H9041  Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side 
  H9042  Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side 
  Q163  Congenital malformation of ear ossicles 
  P113  Birth injury to facial nerve 
  R42  Dizziness and giddiness 
  S0210XA  Unspecified fracture of base of skull, initial encounter for closed fracture 
  S06330A  Contusion and laceration of cerebrum, unspecified, without loss of consciousness, initial encounter 
  S06331A  Contusion and laceration of cerebrum, unspecified, with loss of consciousness of 30 minutes or less, initial encounter 
  S06332A  Contusion and laceration of cerebrum, unspecified, with loss of consciousness of 31 minutes to 59 minutes, initial encounter 
  S06333A  Contusion and laceration of cerebrum, unspecified, with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter 
  S06334A  Contusion and laceration of cerebrum, unspecified, with loss of consciousness of 6 hours to 24 hours, initial encounter 
  S06335A  Contusion and laceration of cerebrum, unspecified, with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter 
  S06336A  Contusion and laceration of cerebrum, unspecified, with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter 
  S06337A  Contusion and laceration of cerebrum, unspecified, with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter 
  S06338A  Contusion and laceration of cerebrum, unspecified, with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter 
  S06339A  Contusion and laceration of cerebrum, unspecified, with loss of consciousness of unspecified duration, initial encounter 
  S064X0A  Epidural hemorrhage without loss of consciousness, initial encounter 
  S065X0A  Traumatic subdural hemorrhage without loss of consciousness, initial encounter 
  S066X0A  Traumatic subarachnoid hemorrhage without loss of consciousness, initial encounter 
  S064X1A  Epidural hemorrhage with loss of consciousness of 30 minutes or less, initial encounter 
  S064X2A  Epidural hemorrhage with loss of consciousness of 31 minutes to 59 minutes, initial encounter 
  S065X1A  Traumatic subdural hemorrhage with loss of consciousness of 30 minutes or less, initial encounter 
  S065X2A  Traumatic subdural hemorrhage with loss of consciousness of 31 minutes to 59 minutes, initial encounter 
  S066X1A  Traumatic subarachnoid hemorrhage with loss of consciousness of 30 minutes or less, initial encounter 
  S066X2A  Traumatic subarachnoid hemorrhage with loss of consciousness of 31 minutes to 59 minutes, initial encounter 
  S064X3A  Epidural hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter 
  S064X4A  Epidural hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter 
  S065X3A  Traumatic subdural hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter 
  S065X4A  Traumatic subdural hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter 
  S066X3A  Traumatic subarachnoid hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter 
  S066X4A  Traumatic subarachnoid hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter 
  S064X5A  Epidural hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter 
  S065X5A  Traumatic subdural hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter 
  S066X5A  Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter 
  S064X6A  Epidural hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
  S064X7A  Epidural hemorrhage with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter 
  S064X8A  Epidural hemorrhage with loss of consciousness of any duration with death due to other causes prior to regaining consciousness, initial encounter 
  S065X6A  Traumatic subdural hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter 
  S065X7A  Traumatic subdural hemorrhage with loss of consciousness of any duration with death due to brain injury before regaining consciousness, initial encounter 
  S065X8A  Traumatic subdural hemorrhage with loss of consciousness of any duration with death due to other cause before regaining consciousness, initial encounter 
  S066X6A  Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter 
  S066X7A  Traumatic subarachnoid hemorrhage with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter 
  S066X8A  Traumatic subarachnoid hemorrhage with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter 
  S064X9A  Epidural hemorrhage with loss of consciousness of unspecified duration, initial encounter 
  S065X9A  Traumatic subdural hemorrhage with loss of consciousness of unspecified duration, initial encounter 
  S066X9A  Traumatic subarachnoid hemorrhage with loss of consciousness of unspecified duration, initial encounter 
  S064X0A  Epidural hemorrhage without loss of consciousness, initial encounter 
  S065X0A  Traumatic subdural hemorrhage without loss of consciousness, initial encounter 
  S066X0A  Traumatic subarachnoid hemorrhage without loss of consciousness, initial encounter 
  S06360A  Traumatic hemorrhage of cerebrum, unspecified, without loss of consciousness, initial encounter 
  S06361A  Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of 30 minutes or less, initial encounter 
  S06362A  Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of 31 minutes to 59 minutes, initial encounter 
  S06363A  Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of 1 hours to 5 hours 59 minutes, initial encounter 
  S06364A  Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of 6 hours to 24 hours, initial encounter 
  S06365A  Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter 
  S06366A  Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter 
  S06367A  Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter 
  S06368A  Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter 
  S06369A  Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of unspecified duration, initial encounter 
  S06890A  Other specified intracranial injury without loss of consciousness, initial encounter 
  S069X0A  Unspecified intracranial injury without loss of consciousness, initial encounter 
  S06891A  Other specified intracranial injury with loss of consciousness of 30 minutes or less, initial encounter 
  S06892A  Other specified intracranial injury with loss of consciousness of 31 minutes to 59 minutes, initial encounter 
  S069X1A  Unspecified intracranial injury with loss of consciousness of 30 minutes or less, initial encounter 
  S069X2A  Unspecified intracranial injury with loss of consciousness of 31 minutes to 59 minutes, initial encounter 
  S06893A  Other specified intracranial injury with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter 
  S06894A  Other specified intracranial injury with loss of consciousness of 6 hours to 24 hours, initial encounter 
  S069X4A  Unspecified intracranial injury with loss of consciousness of 6 hours to 24 hours, initial encounter 
  S06895A  Other specified intracranial injury with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter 
  S069X5A  Unspecified intracranial injury with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter 
  S06896A  Other specified intracranial injury with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter 
  S06897A  Other specified intracranial injury with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter 
  S06898A  Other specified intracranial injury with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter 
  S069X6A  Unspecified intracranial injury with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter 
  S069X7A  Unspecified intracranial injury with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter 
  S069X8A  Unspecified intracranial injury with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter 
  S06899A  Other specified intracranial injury with loss of consciousness of unspecified duration, initial encounter 
  S069X9A  Unspecified intracranial injury with loss of consciousness of unspecified duration, initial encounter 
  S0210XB  Unspecified fracture of base of skull, initial encounter for open fracture 
  S0460XA  Injury of acoustic nerve, unspecified side, initial encounter 
 ICD-10-PCS (effective 10/01/15) F13ZK7Z  Electrocochleography Assessment using Electrophysiologic Equipment 
  F13ZKZZ  Electrocochleography Assessment 
  F13ZL7Z  Auditory Evoked Potentials Assessment using Electrophysiologic Equipment 
  F13ZLZZ  Auditory Evoked Potentials Assessment 
  F13Z1ZZ  Pure Tone Audiometry, Air Assessment 
  F13Z2ZZ  Pure Tone Audiometry, Air and Bone Assessment 
  F13Z3ZZ  Bekesy Audiometry Assessment 
  F13Z4ZZ  Conditioned Play Audiometry Assessment 
  F13Z5ZZ  Select Picture Audiometry Assessment 
  F13Z6ZZ  Visual Reinforcement Audiometry Assessment 
  F13ZDZZ  Tympanometry Assessment 
  F13Z0ZZ  Hearing Screening Assessment 
  F13Z7ZZ Alternate Binaural or Monaural Loudness Balance Assessment 
  F13Z8ZZ  Tone Decay Assessment 
  F13Z9ZZ  Short Increment Sensitivity Index Assessment 
  F13ZBZZ  Short Increment Sensitivity Index Assessment 
  F13ZCZZ  Pure Tone Stenger Assessment 
  F13ZFZZ  Pure Tone Stenger Assessment 
  F13ZGZZ  Acoustic Reflex Patterns Assessment 
  F13ZHZZ  Acoustic Reflex Threshold Assessment 
  F13ZJZZ  Acoustic Reflex Decay Assessment 
  F13ZMZZ  Evoked Otoacoustic Emissions, Screening Assessment 
  F13ZNZZ  Evoked Otoacoustic Emissions, Diagnostic Assessment 
  F13ZPZZ  Aural Rehabilitation Status Assessment 
  F13ZQZZ  Auditory Processing Assessment 
  F13ZQZZ  Auditory Processing Assessment 
  F14Z1ZZ  Ear Canal Probe Microphone Assessment 
  F14Z2ZZ  Monaural Hearing Aid Assessment 
  F14Z3ZZ  Binaural Hearing Aid Assessment 
  F14Z4ZZ  Assistive Listening System/Device Selection Assessment 
  F14Z5ZZ  Sensory Aids Assessment 
  F14Z6ZZ  Binaural Electroacoustic Hearing Aid Check Assessment 
  F14Z7ZZ  Ear Protector Attentuation Assessment 
  F14Z8ZZ  Monaural Electroacoustic Hearing Aid Check Assessment 
  F15Z3ZZ  Oscillating Tracking Assessment
  F15Z5ZZ  Dix-Hallpike Dynamic Assessment 
  F15Z6ZZ  Computerized Dynamic Posturography Assessment 
  F15Z7ZZ  Tinnitus Masker Assessment 
Type of Service Medical   
Place of Service  Office   

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross Blue Shield Association technology assessment program (TEC) and other nonaffiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

"Current Procedural Terminology © American Medical Association. All Rights Reserved" 

History From 2013 Forward     

08/11/2022

Interim review to add codes 92650-92653. No other changes.

11/09/2021 

Annual review, no change to policy intent. 

11/23/2020

Annual review, no change to policy intent. 

11/20/2019 

Annual review, no change to policy intent. 

11/27/2018 

Annual review, no change to policy intent. 

11/15/2017 

Annual review, no change to policy intent 

11/01/2016

Annual review, no change to policy intent 

10/29/2015 

Annual review, no change to policy intent. 

09/21/2015

Added ICD-10 coding. 

11/06/2014 

Annual review, no change to policy intent. Correcting formatting error and added coding section. 

11/01/2013

Added Benefit Application and Rationale.

Complementary Content
${loading}