By Andrea Gohmert and Susan Von Dollen
In January 2021, for the first time since 1996, changes were made to the Current Procedural Terminology (CPT) codes assigned to auditory evoked potentials (AEPs). These changes led to numerous questions from practitioners regarding appropriate coding for auditory evoked potentials and related services.
Descriptions of these new AEP codes (92650 through 92653) were initially released in the CPT manual for 2021 and use of these codes began on January 1, 2021. Overview and discussion of the new codes and reporting have been presented in CPT Assistant, October 2020, p.9, and in an Audiology Today article (Jilla and Burton, 2021).
The objective of this article is to provide a review of these new codes and case-based examples based on member questions.
Newborn Hearing Screening
92650–Auditory evoked potentials: screening of auditory evoked potentials with broadband stimuli, automated analysis
This new code is intended for reporting an automated screening of auditory evoked potential responses. This procedure does not include work related to professional-driven analysis or interpretation of a waveform, but rather for an automated analysis generating a pass/refer or pass/fail result.
Most commonly, this code would be reported for activities related to newborn hearing screenings, but it may have relevant applications among other patient populations (e.g., patients who are difficult to test behaviorally and who also present with significant barriers to completion of diagnostic AEP evaluation).
Diagnostic Auditory Evoked Potentials
92651–Auditory evoked potentials: for hearing status determination, broadband stimuli, with interpretation and report
This code would be reported when performing non-automated testing to confirm presence of neural markers and waveform integrity, rule out auditory neuropathy spectrum disorder, or to determine the need for additional threshold testing.
Description of this code includes obtaining auditory brainstem response (ABR) waveforms using broadband click stimuli at various stimulus intensity levels, as well as manipulation of stimulus polarity.
The most common uses of this CPT code would be initial non-automated newborn hearing screening, follow-up testing or post-screening assessment after failed newborn hearing screening, and to rule out auditory neuropathy spectrum disorder.
92652–Auditory evoked potentials: for threshold estimation at multiple frequencies, with interpretation and report (Do not report 92652 in conjunction with 92651 or 92563)
This code would be reported when completing a more extensive estimation of hearing thresholds and audiometric configuration by measuring ABR or auditory steady state response (ASSR) thresholds at multiple frequencies. Work values for this code include evaluation of the neural integrity of the AEP response.
CPT codes 92651 and 92652 may not be billed together on the same date of service because the work related to hearing status determination is considered and valued as a component of threshold estimation testing (92652).
Activities related to this code include, but are not limited to, assessment after failed newborn hearing screening and estimation of hearing thresholds for individuals who are unable to volunteer behavioral responses.
CPT code 92562 can also encompass activities related to evaluation, interpretation, and report of AEPs of varying latencies (e.g., middle latency auditory evoked potentials (MLAEP) or cortical auditory evoked potentials (CAEP)), if completed in addition to threshold estimation at multiple frequencies. It should be noted that 92652 can only be reported once per patient per day and CPT codes 92562 and 92563 may not be billed together on the same date of service.
92653–Auditory evoked potentials: neurodiagnostic with interpretation and report
This code would be reported when completing a comprehensive neurodiagnostic evaluation of the auditory nerve or brainstem nuclei to determine neurologic site of lesion, including all AEP (ABR, MLAEP, and CAEP), that does not involve hearing status determination or threshold estimation.
It should be noted that the work related to the analysis of the neural integrity of the AEP response is also included in valuation for codes 92651 and 92652. Therefore, it is not appropriate to report 92653 on the same date of service as 92651 or 92652.
Case Example 1
A baby was born at home and missed his initial newborn hearing screening. He was seen for his initial newborn screening and did not pass in either ear. You use a non-automated system to complete post-screening ABR evaluation, using a broadband stimulus at multiple intensities and manipulating stimulus polarity to determine hearing status.
What AEP code do you use for billing purposes? 92651 only
Case Example 2
A patient was referred to your clinic for a comprehensive hearing evaluation and seems to be exhibiting a non-organic hearing loss. You perform a broadband-evoked ABR evaluation and estimate frequency-specific ABR thresholds at multiple frequencies in each ear to confirm or rule out hearing loss.
What AEP code do you use for billing purposes? Answer: 92652 only
Case Example 3
A child is referred to your clinic for a comprehensive ABR evaluation in the setting of concerns for auditory processing disorder. You complete a neurodiagnostic ABR evaluation and assess middle latency AEP responses along with cortical AEP responses as part of an auditory-processing evaluation.
What AEP code do you use for billing purposes? Answer: 92653 only
Case Example 4
A child was referred to your clinic to rule out ANSD. You perform AEP testing at multiple intensities using a broadband stimulus to rule out auditory neuropathy spectrum disorder (ANSD) only.
What AEP code do you use for billing purposes? Answer: 92651 only
Case Example 5
You see a patient for determination of hearing status and use frequency-specific ASSR testing to estimate thresholds.
What AEP code do you use for billing purposes? Answer: 92652 only
NOTE: CPT codes, descriptions, and other data are copyright 1966, 1970, 1973, 1977, 1981, 1983–2021 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
The information provided in this article by the American Academy of Audiology Coding and Reimbursement Committee is to provide general information and educational guidance to audiologists. Action taken with respect to the information provided is an individual choice. The American Academy of Audiology hereby disclaims any responsibility for the consequences of any action(s) taken by any individual(s) as a result of using the information provided, and the reader agrees not to take action against, or seek to hold, or hold liable, the American Academy of Audiology for the reader’s use of the information provided. As used herein, the “American Academy of Audiology” shall be defined to include the Academy’s directors, officers, employees, volunteers, members, and agents.
This article is a part of the July/August 2021 Audiology Today issue.
American Academy of Audiology. (2020) New Audiology CPT Codes for 2021. www.audiology.org/practice_management/coding/new-audiology-cpt-codes-2021 (accessed November 24, 2020).
American Academy of Audiology. (2020) 2021 Medicare Physician Fee Schedule (PFS) Summary. www.audiology.org/practice_management/reimbursement/2021-medicare-physician-fee-schedule-pfs-summary (accessed November 24, 2020).
American Medical Association. (2020) AMA Releases 2021 CPT Code Set. www.ama-assn.org/press-center/press-releases/ama-releases-2021-cpt-code-set (accessed November 24, 2020).
American Medical Association, CPT Assistant. Auditory Evoked Potentials Updates (October 2020, p.9).