2023 Propose Rule on the Hospital Outpatient Prospective Payment System (OPPS)

Tables 1-7 see below for Ambulatory Payment Classification (APC) assignments, status indicators (SI), and reimbursement amounts for audiology codes. An “S” status indicator denotes a “Separate APC Payment,” where regardless of services performed on the same date of service, the CPT code is paid at the APC rate.

A “Q1” status indicator represents “STV-Packaged Codes” where APCs and CPT codes billed on the same date of service as those assigned a status indicator of “S”, “T” or “V” are packaged and not paid for separately. If billed without the “S,” “T,” or “V” service, payment is made at the APC rate.

Status indicator “N” indicates payment is packaged into payment for other services, therefore no separate APC payment will be allowed. Status indicator “E1” is not paid by Medicare when submitted on outpatient claims.  CPT 92650 (Aep scr auditory potential) has a status indicator of E1 and is not assigned to an APC.

Table 1: APC 5721-Level I Diagnostic Tests and Related Services

(2021 final = $139.55)
(2022 final = $142.59)
(2023 proposed = $148.58)

CPT CodeCode Descriptor2021 Final SI2022 Final2023 Proposed
92537Caloric vestibular test with recording, bilateral; bithermaSSS
92538Caloric vestibular test with recording, bilateral; monothermalSSS
92540Basic vestibular evaluationSSS
92544Optokinetic nystagmus test, bidirectional, foveal or peripheral stim, w/recordingpSSS
92546Sinusoidal vertical axis rotational testingSSS
92584ElectrocochleographySSS
92601Cochlear Implant initial programming <7 years oldSSS
92602Subsequent programming <7 years oldSSS
92603Cochlear implant initial programming > 7 years oldSSS
92604 Subsequent programming >7 years oldSSS
92640Auditory brainstem implant programmingSSS
92550Tympanometry & reflex thresholdQ1Q1Q1
92553Audiometry air and boneQ1Q1Q1
92557Comprehensive hearing evaluationQ1 Q1Q1
92562Loudness balance testQ1Q1Q1
92570Acoustic immitance testingQ1Q1Q1
92572Staggered spondaic word testQ1Q1Q1
92579Visual audiometry (VRA)Q1Q1Q1
92582Conditioning play audiometryQ1Q1Q1
92620Auditory function test (60 min)Q1Q1Q1
92625Tinnitus assessmentQ1Q1Q1
92626Evaluation of auditory rehab statusQ1Q1Q1
92651Aep hearing status deter i&rSSS
92517Vemp test i&r cervicalSSS
92518Vemp test i&r ocularSSS

Table 2: APC 5722-Level II Diagnostic Tests and Related Services

(2021 final = $264.45)
(2022 final = $270.29)
(2023 proposed = $285.63)

CPT CodeCode Descriptor2021 Final SI2022 Final2023 Proposed
92545Oscillating tracking test with recordingSSS
92587OAEs, limitedSSS
92588OAEs, comprehensiveSSS
92519Vemp tst i&r cervical&ocularSSS
92652Aep thrshld est mlt freq i&rSSS
92653Aep neurodiagnostic i&rSSS

Table 3: APC 5723-Level III Diagnostic Tests and Related Services

(2021 final = $487.78)
(2022 final = $498.53)
(2023 proposed = $493.29)

CPT CodeCode Descriptor2021 Final SI2022 Final2023 Proposed
92577Stenger test, speechQ1Q1Q1

Table 4: APC 5731-Level I Minor Procedures

(2021 final = $24.67)
(2022 final = $25.23)
(2023 proposed = $14.00)

CPT CodeCode Descriptor2021 Final SI2022 Final2023 Proposed
92700Unlisted otorhinolaryngological service or procedureQ1Q1Q1

Table 5: APC 5732-Level II Minor Procedures

(2021 final = $33.84)
(2022 final = $34.57)
(2023 proposed = $34.61)

CPT CodeCode Descriptor2021 Final SI2022 Final2023 Proposed
92555Speech threshold audiometryQ1Q1Q1
92563Tone decay hearing testQ1Q1Q1
92565Stenger test, pure toneQ1Q1Q1
92567TympanometryQ1Q1Q1
92568Acoustic reflex thresholdQ1Q1Q1
92571Filtered speech testQ1Q1Q1
92575Sensorineural acuity testQ1Q1Q1
92576Synthetic sentence testQ1Q1Q1
92596Ear protection measurementQ1Q1Q1

Table 6: APC 5733–Level III Minor Procedures   

(2021 final = $55.66)
(2022 final = $56.85)
(2023 proposed = $58.50)

CPT CodeCode Descriptor2021 Final  SI2022 Final2023 Proposed
92556Speech threshold and discriminationQ1Q1Q1
92583Select picture audiometryQ1Q1Q1

Table 7: APC 5734-Level IV Minor Procedures

(2021 final = $111.95)
(2022 final = $115.16)
(2023 proposed = $118.32)

CPT CodeCode Descriptor2021 Final SI2022 Final2023 Proposed
92541Spontaneous nystagmus testQ1Q1Q1
92542Positional nystagmus testQ1Q1Q1
92548PosturographyQ1Q1Q1
92549Cdp-sot 6 cond w/i&r mct&adtQ1Q1Q1
92552Pure tone audiometry airQ1Q1Q1
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