CPT code 69210, Removal impacted cerumen, (separate procedure) one or both ears.
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Need to insert a link to the PDF for the AT article for reimbursement options for cerumen management here
Q: Can I bill Medicare for cerumen removal?
A. Because audiologists are reimbursed foronly diagnostic services under the Medicare program, cerumen removal is considered an excluded, non-coveredservice; 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 procedureso 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, usethe GY (procedure is not a covered service) and -GX (voluntary ABN issued to patient).
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