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 on CMS’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 review CMS’ guidance 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 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?|
|92540||92270,92541, 92542, 92544, 92545||No||No|
|92541||92542, 92544, 92545||Yes||Yes||-59|
|92557||92552, 92553, 92555, 92556||No||No|
|92570||92550, 92567, 92568||No||No|
|92620||92571, 92572, 92576||No||No|
|92621||92571, 92572, 92576||No||No|
|92640||92507, 92508, 92550, 92552, 92553, 92555, 92556, 92557, 92558, 92561-92568, 92570-92572, 92575-92577, 92579, 92582-92588, 92596, 97755||Yes||Yes||-59|
Table 1. CCI Edits for Cochlear Implant Programming
|Column 1||Column 2|
|CPT Procedure Code (one)||CPT Procedure Code (one)||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, 92585, 92586, 92604, 92626||Yes||Yes||-59|
|92601||92552-92565, 92571-92584, 92587-92588, 92596-92597, 92602, 96532,97755||No||No|
|92602||92507, 92508, 92521-92524, 92550, 92567, 92568, 92570, 92585, 92586, 92626||Yes||Yes||-59|
|92602||92552-92565, 92571-92584, 92587-92588, 92596-92597, 92604, 96532, 97755||No||No|
|92603||92507, 92508, 92521-92524, 92550, 92567, 92568, 92570, 92585, 92586, 92602, 92626||Yes||Yes||-59|
|92603||92552-92565, 92571-92584, 92587-92597, 92603, 92604, 96523||No||No|
|92604||92507, 92508, 92521-92524, 92550, 92567, 92568, 92570, 92585, 92586, 92626||Yes||Yes||-59|
|92604||92552-92565, 92571-92584, 92587-92597, 96523, 97755||No||No|
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