National Correct Coding Initiative (CCI) Edits for Audiology Procedures

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
92542	92544, 92545	Yes	Yes	-59
92544	92545	Yes	Yes	-59
92550	92567, 92568	No	No
92553	92552, 92556	No	No
92556	92555	No	No
92557	92552, 92553, 92555, 92556	No	No
92563	92552, 92553	No	No
92568	92567	No	No
92570	92550, 92567, 92568	No	No
92585	92586	No	No
92588	92587	Yes	Yes	-59
92620	92571, 92572, 92576	No	No
92620	92626	Yes	Yes	-59
92621	92571, 92572, 92576	No	No
92625	92562	Yes	Yes	-59
92626	92621	Yes	Yes	-59
92640	92507, 92508, 92550, 92552, 92553, 92555, 92556, 92557, 92558, 92561-92568, 92570-92572, 92575-92577, 92579, 92582-92588, 92596, 97755	Yes	Yes	-59

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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