The National Health Interview Survey found that approximately 10 percent of U.S. adults had experienced tinnitus in the 12 months previous to the survey (Bhatt et al, 2016; Shargorodsky et al, 2010). This article reviews codes useful when providing tinnitus services. For clinical guidance, the interested reader is directed to the American Academy of Otolaryngology Head and Neck Surgery Clinical Practice Guideline for Tinnitus (Tunkel et al, 2014). Although tinnitus services and devices are billed to a variety of payers, this article focuses on guidance for filing claims for Medicare beneficiaries and appropriate coding based on procedures chosen at the discretion of the clinician.

Evaluation and Associated Current Procedural Terminology (CPT) Codes

The following diagnostic procedures are commonly used by audiologists in audiologic assessments for patients with tinnitus.

CPT CODE

DESCRIPTION

92557

Comprehensive audiometry, threshold evaluation and speech recognition (92553 and 92556 combined)

92567

Tympanometry (Impedance testing)

92550

Tympanometry and acoustic reflex threshold measurements

92570

Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing and acoustic reflex decay testing.

92587

Distortion product otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report

92588

Distortion product-evoked otoacoustic emissions; comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report

 

All codes presented in this section assume binaural procedures; if only one ear is tested, usage of the -52 Reduced Services modifier is recommended. As a reminder, under the description for 92557—Comprehensive audiometry, threshold evaluation, and speech recognition—all four components (air- and bone-conduction pure-tone testing, speech-recognition threshold, and suprathreshold word discrimination) should be completed. 

For more specific coding information for acoustic reflex threshold measurement (included in 92550: Tympanometry and acoustic reflex threshold measurements and 92570: Acoustic immittance testing) and appropriate use of 92587: Distortion product otoacoustic emissions, limited evaluation and 92588: Distortion product otoacoustic emissions, comprehensive diagnostic evaluation, the reader is directed to the Coding and Reimbursement section of the Academy’s website, www.audiology.org (American Academy of Audiology, 2019).

Tinnitus Evaluation

Measurements of tinnitus can be useful to document its presence, to demonstrate the need for counseling, and to guide and monitor progress with treatment options such as sound therapy. Tinnitus assessment is encompassed by one code, 92625: Assessment of tinnitus. As with other audiology procedure codes, 92625 is a bilateral code and usage of the -52 Reduced Services modifier is recommended for unilateral testing.

CPT CODE

DESCRIPTION

92625

Assessment of tinnitus (includes pitch, loudness matching, and masking)

 

Voluntary or mandatory quality reporting through the Merit-Based Incentive Payment System (MIPS) program may also require the use of additional components in tinnitus assessment. Some patients can have strong emotional reactions to their tinnitus (Tyler and Baker, 1983), including depression (Langguth et al, 2011). There is a quality measure associated with a billed 92625: Assessment of tinnitus, MIPS Measure #134. Detailed information on MIPS reporting for 2020 can be found in the January/February 2020 issue of Audiology Today (Kovar, 2020).

MEASURE #134: PREVENTATIVE CARE AND SCREENING: SCREENING FOR CLINICAL DEPRESSION AND FOLLOW-UP PLAN

Definition: For practitioners participating in the MIPS program, patients undergoing 92625: Assessment of tinnitus should complete a standardized depression screening tool. If applicable, a follow-up plan should be established and may include referral to a practitioner who is qualified to diagnose the condition and/or additional evaluation.

G8431

+

Positive screen for clinical depression using an age-appropriate standardized tool and a follow-up plan documented

G8510

+

Negative screen for clinical depression using an age-appropriate standardized tool, follow-up not required

G9717

*

Documentation stating patient has active diagnosis of depression or has diagnosed bipolar disorder by a physician or mental health professional, screening not required

G8433

*

Screening for clinical depression using an age-appropriate standardized tool not documented, patient not eligible/ refuses to participate

G8432

No documentation of clinical depression screening using an age appropriate standardized tool

G8511

Positive screen for clinical depression using an age-appropriate standardized tool documented, follow-up plan not documented, reason not specified

+ MIPS performance standards met
* Denominator exception (partial points awarded toward quality score)
Performance standard not met

For more information on scoring and reporting of MIPS measures, readers are encouraged to review resources from the Centers for Medicare and Medicaid Services (CMS) website (CMS, 2020).

Tinnitus Diagnosis 

The current ICD-10 code set provides two classifications: tinnitus and pulsatile tinnitus. Subjective tinnitus can be perceived only by the patient. Objective tinnitus can be perceived by the patient and the examiner.

ICD-10 DIAGNOSIS CODES

DESCRIPTION

H93.11 Tinnitus
(right ear)

H93.12 Tinnitus
(left ear)

H93.13 Tinnitus
(bilateral)

H93.19 Tinnitus
(unspecified ear)

A perceived sound in the absence of an external sound that can be described as a ringing, clicking, whooshing, crickets, radio static, etc., and can be subjective or objective in nature

H93.A1 Pulsatile tinnitus
(right ear)

H93.A2 Pulsatile tinnitus
(left ear)

H93.A3 Pulsatile tinnitus
(bilateral)

H93.A9 Pulsatile tinnitus
(unspecified ear)

A perceived sound that coincides with the heartbeat

Tinnitus Management

Hearing Aid Evaluation, Dispensing, and Fitting

An exhaustive review of codes used in hearing aid evaluation, dispensing, and fitting is outside of the scope of this resource. The interested reader is directed to the Academy’s Guide to Itemizing Your Professional Services (American Academy of Audiology, 2014).

Non-Covered Services and Devices

Medicare does not cover audiological treatment options for tinnitus such as hearing aids, sound therapy devices, tinnitus maskers, tinnitus treatment, or counseling. These items and services should not be billed to Medicare for reimbursement. 

In the event that a claim needs to be submitted for denial or the patient requests that the claim be submitted to Medicare, the -GY modifier (Item or service statutorily excluded, does not meet the definition of any Medicare benefit) must be used with any codes used for tinnitus treatment. For more information on the use of modifiers when billing Medicare, the reader is directed to the September/October 2019 issue of Audiology Today (Frank and Jilla, 2019).

Conclusion

In comparison to the 30 million Americans with hearing loss, 50 million Americans report tinnitus. The addition of tinnitus evaluation, diagnosis, and management provides an opportunity to help more patients by mitigating the effects of this disorder. Additional articles on adding tinnitus to your practice are provided by Tyler et al (2008) and Turiff (2017).