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October 6, 2022

National Correct Coding Initiative (CCI) Edits for Audiology Procedures

  • Coding and Reimbursement

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 onย CMSโ€™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 reviewย ย CMSโ€™ guidanceย 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 1CPT Procedure Code (one) Column 2CPT Procedure Code (one) Can be performed on the same date of service in anย office setting? Can be performed on the same date of service inย hospital outpatient settings? If can be performed on the same date of service, what modifier should be used?
92517 92518, 92519 No No ย 
92519 92518 No No ย 
92537 92538 No No ย 
92540 92541, 92542, 92544, 92545 No No ย 
92541 92542, 92544, 92545 Yes Yes -59
92542 92544, 92545 Yes Yes -59
92544 92545 Yes Yes -59
92549 92548 No No ย 
92550 92567, 92568 No No ย 
92553 92552, 92556 No No ย 
92556 92555 No No ย 
92557 92552, 92553, 92555, 92556 No No ย 
92563 92552, 92553 No No ย 
92568 92567 No No ย 
92570 92550, 92567, 92568 No No ย 
92587, 92588 92558 No No ย 
92588 92587 Yes Yes -59
92590 – 92595 92626, 92627 No No ย 
92620 92571, 92572, 92576 No No ย 
92620, 92621 92571, 92572, 92576 No No ย 
92620 92626 Yes Yes -59
92625 92562 Yes Yes -59
92626 92621 Yes Yes -59
92640 92507, 92508, 92550, 92552, 92553, 92555, 92556, 92557, 92558, 92561-92565, 92568, 92570-92572, 92575-92577, 92579, 92582-92584, 92587, 92588, 92596, 92650 โ€“ 92653, 97755, 0208T โ€“ 0212T Yes Yes -59
92651 92653 No No ย 
92652 92651, 92653 No No ย 

Table 2. CCI Edits for Cochlear Implant Programming

Column 1 Column 2 ย  ย  ย 
CPT Procedure Code (one) CPT Procedure Code (one)ย  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, 92521 -92524, 92550, 92567, 92568, 92570, 92602, 92626, 92650 – 92653 Yes Yes -59
92601 92552, 92553, 92555 โ€“ 92558, 92561 – 92565, 92571, 92572, 92575 โ€“ 92577, 92579, 92582 โ€“ 92584,ย  92587, 92588, 92596, 92597, 92603, 92604, 97755, 0208T โ€“ 0212T No No ย 
92602 92507, 92508, 92521-92524, 92550, 92567, 92568, 92570, 92626, 92650 – 92653 Yes Yes -59
92602 92552, 92553, 92555 -92558, 92561 โ€“ 92565, 92571, 92572, 92575 โ€“ 92577, 92579, 92582 โ€“ 92584, 92587, 92588, 92596, 92597, 92603, 92604, 97755, 0208T โ€“ 0212T No No ย 
92603 92507, 92508, 92521-92524, 92550, 92567, 92568, 92570, 92604, 92626, 92650 – 92653 Yes Yes -59
92603 92552, 92553, 92555 โ€“ 92558, 92561-92565, 92571 92572, 92575-92577, 92579, 92582-92584,92587, 92588, 92596, 92597, 92602, 97755, 0208T โ€“ 0212T No No ย 
92604 92507, 92508, 92521-92524, 92550, 92567, 92568, 92570, 92626, 92650 – 92653 Yes Yes -59
92604

92552, 92553, 92555 โ€“ 92558, 92561 โ€“ 92565, 92571, 92572, 92575 โ€“ 92577, 92579, 92582 โ€“ 92584, ย 92587, 92588, 92596, 92597, 97755, 0208T โ€“ 0212T

No No ย 
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