CPT code 69210, Removal impacted cerumen, (separate procedure) one or both ears.
Q: Can I bill Medicare for cerumen removal?
A: Because audiologists are reimbursed for only diagnostic services under the Medicare program, cerumen removal is considered an excluded, non-covered service; therefore the patient should pay for the service at the time it is rendered. A voluntary AdvancedBeneficiary Notice (ABN) may be offered to the patient prior to performing the procedures so they are aware of their fiscal responsibility, should they choose to have this procedure performed.
Q: Does the claim have to be submitted to Medicare?
A: Non-covered services are typically not submitted to Medicare however, some third party payers do reimburse for cerumen removal when performed by an audiologist. If you must bill Medicare for a third party denial, use the GY (procedure is not a covered service) and -GX (voluntary ABN issued to patients).
Q: Do commercial insurance plans reimburse audiologists for impacted cerumen removal?
A: Some commercial payers reimburse audiologists for impacted cerumen removal.
Q: Can a state licensed/nationally certified audiologist bill Medicare for an otoscopic exam and wax removal?
A: An otoscopic examination is considered part of a general examination and is not a separately reportable service. Medicare does not cover cerumen removal when performed by an audiologist.
Q: What is the definition of impacted cerumen does the ear canal have to be totally occluded?
A: The term impacted cerumen includes instances of when the ear canal is not totally occluded. The definition of impacted cerumen provided by AAO-HNS in CPT Assistant July 2005 is as follows: If any one or more of the following are present, cerumen should be considered impacted clinically:
- Visual considerations: Cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition.
- Qualitative considerations: Extremely hard, dry, irritative cerumen causing symptoms such as pain, itching, hearing loss, etc.
- Inflammatory considerations: Associated with foul odor, infection, or dermatitis.
- Quantitative considerations: Obstructive, copious cerumen that cannot be removed without magnification and multiple instrumentations