Tables 1-6 see below for APC assignments, status indicators, and reimbursement amounts for audiology codes. An “S” status indicator denotes a “Separate APC Payment” where regardless of services performed on the same date of service, the CPT code is paid at the APC rate. A “Q1” status indicator represents “STV-Packaged Codes” where APCs and CPT codes billed on the same date of service as those assigned a status indicator of “S”, “T” or “V” are packaged and not paid for separately. If billed without the “S,” “T,” or “V” service, payment is made at the APC rate. Status indicator “N” indicates payment is packaged into payment for other services, therefore no separate APC payment will be allowed.
Table 1: APC 5721-Level I Diagnostic Tests and Related Services (2018 final = $136.31)
- (2019 final = $135.95)
- (2020 proposed = $140.33)
- (2020 final = $138.33)
CPT Code | Code Descriptor | Status Indicator 2018 Final | Status Indicator 2019 Final | Status Indicator 2020 Final |
92537 | Caloric vestibular test with recording, bilateral; bithermal* moved here from APC 5722 | S | S | S |
92538 | Caloric vestibular test with recording, bilateral; monothermal* moved here from APC 5722 | S | S | S |
92540 | Basic vestibular evaluation | S | S | S |
92544 | Optokinetic nystagmus test, bidirectional, foveal or peripheral stim, w/recording | S | S | S |
92545 | Oscillating tracking test, with recording | S | S | S |
92546 | Sinusoidal vertical axis rotational testing | S | S | S |
92584 | Electrocochleography | S | S | S |
92586 | Auditory evoked potentials, limited | S | S | S |
92601 | Cochlear Implant initial programming <7 years old | S | S | S |
92602 | Subsequent programming <7 years old | S | S | S |
92603 | Cochlear implant initial programming >7 years old | S | S | S |
92604 | Subsequent programming >7 years old | S | S | S |
92640 | Auditory brainstem implant programming | S | S | S |
92550 | Tympanometry & reflex threshold | Q1 | Q1 | Q1 |
92553 | Audiometry air and bone | Q1 | Q1 | Q1 |
92557 | Comprehensive hearing evaluation | Q1 | Q1 | Q1 |
92562 | Loudness balance test | Q1 | Q1 | Q1 |
92570 | Acoustic immittance testing | Q1 | Q1 | Q1 |
92572 | Staggered spondaic word test | Q1 | Q1 | Q1 |
92579 | Visual audiometry (VRA) | Q1 | Q1 | Q1 |
92582 | Conditioning play audiometry | Q1 | Q1 | Q1 |
92620 | Auditory function test (60 min) | Q1 | Q1 | Q1 |
92625 | Tinnitus assessment | Q1 | Q1 | Q1 |
92626 | Evaluation of auditory rehab status | Q1 | Q1 | Q1 |
Table 2: APC 5722-Level II Diagnostic Tests and Related Services (2018 final = $248.81)
- (2019 final = $252.31)
- (2020 proposed = $256.60)
- (2020 final = $253.07)
CPT Code | Code Descriptor | Status Indicator 2018 Final | Status Indicator 2019 Final | Status Indicator 2020 Final |
92585 | Auditory evoked potentials (ABR), comprehensive | S | S | S |
92587 | OAEs, limited | S | S | S |
92588 | OAEs, comprehensive | S | S | S |
Table 3: APC 5723-Level III Diagnostic Tests and Related Services (2018 final = $444.36)
- (2019 final = $455.27)
- (2020 proposed = $486.65)
- (2020 final = $485.55)
CPT Code | Code Descriptor | Status Indicator 2018 Final | Status Indicator 2019 Final | Status Indicator 2020 Final |
92577 | Stenger test, speech | Q1 | Q1 | Q1 |
Table 4: APC 573-Level I Minor Procedures (2018 final =$17.47)
- (2019 final = $17.17)
- (2020 proposed = $23.57)
- (2020 final = $ 22.98)
CPT Code | Code Descriptor | Status Indicator 2018 Final | Status Indicator 2019 Final | Status Indicator 2020 Final |
92564 | SISI hearing test* moved here from APC 5732 | Q1 | Q1 | Q1 |
92700 | Unlisted otorhinolaryngological service or procedure | Q1 | Q1 | Q1 |
Table 5: APC 5732-Level II Minor Procedures (2018 final = $31.80)
- (2019 final = $32.12)
- (2020 proposed = $34.33)
- (2020 final = $33.43)
CPT Code | Code Descriptor | Status Indicator 2018 Final | Status Indicator 2019 Final | Status Indicator 2020 Final |
92555 | Speech threshold audiometry | Q1 | Q1 | Q1 |
92556 | Speech threshold and discrimination | Q1 | Q1 | Q1 |
92563 | Tone decay hearing test | Q1 | Q1 | Q1 |
92565 | Stenger test, pure tone | Q1 | Q1 | Q1 |
92567 | Tympanometry | Q1 | Q1 | Q1 |
92568 | Acoustic reflex threshold | Q1 | Q1 | Q1 |
92571 | Filtered speech test | Q1 | Q1 | Q1 |
92575 | Sensorineural acuity test | Q1 | Q1 | Q1 |
92576 | Synthetic sentence test | Q1 | Q1 | Q1 |
92583 | Select picture audiometry | Q1 | Q1 | Q1 |
92596 | Ear protection measurement | Q1 | Q1 | Q1 |
Table 6: APC 5734-Level IV Minor Procedures (2018 final = $105.03)
- (2019 final = $106.48)
- (2020 proposed = $109.98)
- (2020 final = $109.02)
CPT Code | Code Descriptor | Status Indicator 2018 Final | Status Indicator 2019 Final | Status Indicator 2020 Final |
92541 | Spontaneous nystagmus test | Q1 | Q1 | Q1 |
92542 | Positional nystagmus test | Q1 | Q1 | Q1 |
92548 | Posturography | Q1 | Q1 | Q1 |
92552 | Pure tone audiometry air | Q1 | Q1 | Q1 |
92561 | Bekesy audiometry diagnosis | Q1 | Q1 | Q1 |
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