This article is a part of the May/June 2026, Volume 38, Number 3, Audiology Today issue.
By David Zapala, PhD
When assessing adults who report hearing difficulties, audiologists practicing at the top of their license perform a thorough review of records and a structured interview to gather a comprehensive medical, family, and social history and to clearly define the nature of the patient’s concerns. They perform specific audiological tests and synthesize all this information into a formalized assessment and treatment plan. After all that, if the patient is a Medicare Part B beneficiary, the audiologist typically only charges Medicare-allowed Current Procedural Terminology (CPT®) codes. Diagnostic hearing tests are covered. Treatment is not.
But the recent addition of hearing aid service CPT codes includes a game changer: CPT 92628 (Evaluation of hearing aid candidacy…, including review and integration of audiological function tests, assessment, and interpretation of hearing needs, discussion of candidacy results, counseling on treatment options…, and when performed, assessment of cognitive and communication status). CPT 92628 captures the assessment, clinical decision making, and management work typically used to establish a plan of care. The code is time-based and can be reported when performing these services, provided the time requirement is met.
CPT 92628 is a game changer in three ways. First, it defines the work (assessment, clinical decision-making, and counseling) involved in developing a plan of care. Using the code helps others recognize that audiologists provide this kind of cognitive work. Second, it requires that these activities be documented. Formulating an assessment statement about an individual’s hearing needs is not the same thing as describing the results of an audiogram—people have needs; tests do not. Document your clinical reasoning (what the needs are and how the findings support the plan), not just the test results. Finally, because Medicare statutory restrictions preclude coverage of audiologist-provided treatment and hearing aid related services, the code is not covered by Medicare. It falls to the audiologist to document appropriately and determine what to charge the patient for this Medicare-excluded service.
This is an important addition to the Evaluative and Therapeutic Section for the American Medical Association CPT code set. Audiologists now have a code to describe the work that goes beyond the initial functional audiology diagnostic tests. Use CPT 92628 to make that work visible.
What to Do Next
Use CPT 92628 when you are performing treatment option counseling, hearing aid candidacy counseling, or integrating a communication or cognitive assessment that will inform a recommended plan of care.
Remember to provide a brief patient-facing notice explaining that this service is a Medicare-excluded service and may be the patient’s financial responsibility.
Track and document the total clinician time spent on these activities, and report only when the code’s time requirement is met.
Document the key decision-making: the patient’s hearing needs (not just test results), your interpretation/integration of findings, and the resulting plan.
How does it help to charge a patient for a code that is not Medicare-covered, particularly when audiologists compete with other hearing-health care providers? Perhaps a better question is: When do we evaluate someone with hearing difficulties without formulating an assessment of hearing needs, assessing hearing aid candidacy, or discussing treatment options? Of course, these activities are foundational to our profession! Too often, we provide these services free of charge, but they have tremendous value. Their cost is applied to and reflected in our overhead practice expense, which is then funded by and increases the cost of other services such as device sales. I simply suggest that we unbundle these costs. Lower your overhead costs by charging for CPT 92628 services whenever you provide them. This suggestion not only improves transparency but also helps differentiate audiologists from other hearing-health care providers.
I offer my congratulations to the Academy’s Advocacy Council as well as the Practicing Physicians Advisory Committee (PPAC), CPT®, Relative Value Scale Update Committee (RUC), and Relativity Assessment Workgroup (RAW) seat holders for guiding these codes to fruition. Well done!
David Zapala, PhD
President
