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 Code | Code Descriptor | 2021 Final SI | 2022 Final | 2023 Proposed |
92537 | Caloric vestibular test with recording, bilateral; bitherma | S | S | S |
92538 | Caloric vestibular test with recording, bilateral; monothermal | S | S | S |
92540 | Basic vestibular evaluation | S | S | S |
92544 | Optokinetic nystagmus test, bidirectional, foveal or peripheral stim, w/recordingp | S | S | S |
92546 | Sinusoidal vertical axis rotational testing | S | S | S |
92584 | Electrocochleography | S | S | S |
92601 | Cochlear Implant initial programming <7 years old | S | S | S |
92602 | Subsequent programming <7 years old | S | S | S |
92603 | Cochlear implant initial programming > 7 years old | S | S | S |
92604 | Subsequent programming >7 years old | S | S | S |
92640 | Auditory brainstem implant programming | S | S | S |
92550 | Tympanometry & reflex threshold | Q1 | Q1 | Q1 |
92553 | Audiometry air and bone | Q1 | Q1 | Q1 |
92557 | Comprehensive hearing evaluation | Q1 | Q1 | Q1 |
92562 | Loudness balance test | Q1 | Q1 | Q1 |
92570 | Acoustic immitance testing | Q1 | Q1 | Q1 |
92572 | Staggered spondaic word test | Q1 | Q1 | Q1 |
92579 | Visual audiometry (VRA) | Q1 | Q1 | Q1 |
92582 | Conditioning play audiometry | Q1 | Q1 | Q1 |
92620 | Auditory function test (60 min) | Q1 | Q1 | Q1 |
92625 | Tinnitus assessment | Q1 | Q1 | Q1 |
92626 | Evaluation of auditory rehab status | Q1 | Q1 | Q1 |
92651 | Aep hearing status deter i&r | S | S | S |
92517 | Vemp test i&r cervical | S | S | S |
92518 | Vemp test i&r ocular | S | S | S |
Table 2: APC 5722-Level II Diagnostic Tests and Related Services
(2021 final = $264.45)
(2022 final = $270.29)
(2023 proposed = $285.63)
CPT Code | Code Descriptor | 2021 Final SI | 2022 Final | 2023 Proposed |
92545 | Oscillating tracking test with recording | S | S | S |
92587 | OAEs, limited | S | S | S |
92588 | OAEs, comprehensive | S | S | S |
92519 | Vemp tst i&r cervical&ocular | S | S | S |
92652 | Aep thrshld est mlt freq i&r | S | S | S |
92653 | Aep neurodiagnostic i&r | S | S | S |
Table 3: APC 5723-Level III Diagnostic Tests and Related Services
(2021 final = $487.78)
(2022 final = $498.53)
(2023 proposed = $493.29)
CPT Code | Code Descriptor | 2021 Final SI | 2022 Final | 2023 Proposed |
92577 | Stenger test, speech | Q1 | Q1 | Q1 |
Table 4: APC 5731-Level I Minor Procedures
(2021 final = $24.67)
(2022 final = $25.23)
(2023 proposed = $14.00)
CPT Code | Code Descriptor | 2021 Final SI | 2022 Final | 2023 Proposed |
92700 | Unlisted otorhinolaryngological service or procedure | Q1 | Q1 | Q1 |
Table 5: APC 5732-Level II Minor Procedures
(2021 final = $33.84)
(2022 final = $34.57)
(2023 proposed = $34.61)
CPT Code | Code Descriptor | 2021 Final SI | 2022 Final | 2023 Proposed |
92555 | Speech threshold audiometry | Q1 | Q1 | Q1 |
92563 | Tone decay hearing test | Q1 | Q1 | Q1 |
92565 | Stenger test, pure tone | Q1 | Q1 | Q1 |
92567 | Tympanometry | Q1 | Q1 | Q1 |
92568 | Acoustic reflex threshold | Q1 | Q1 | Q1 |
92571 | Filtered speech test | Q1 | Q1 | Q1 |
92575 | Sensorineural acuity test | Q1 | Q1 | Q1 |
92576 | Synthetic sentence test | Q1 | Q1 | Q1 |
92596 | Ear protection measurement | Q1 | Q1 | Q1 |
Table 6: APC 5733–Level III Minor Procedures
(2021 final = $55.66)
(2022 final = $56.85)
(2023 proposed = $58.50)
CPT Code | Code Descriptor | 2021 Final SI | 2022 Final | 2023 Proposed |
92556 | Speech threshold and discrimination | Q1 | Q1 | Q1 |
92583 | Select picture audiometry | Q1 | Q1 | Q1 |
Table 7: APC 5734-Level IV Minor Procedures
(2021 final = $111.95)
(2022 final = $115.16)
(2023 proposed = $118.32)
CPT Code | Code Descriptor | 2021 Final SI | 2022 Final | 2023 Proposed |
92541 | Spontaneous nystagmus test | Q1 | Q1 | Q1 |
92542 | Positional nystagmus test | Q1 | Q1 | Q1 |
92548 | Posturography | Q1 | Q1 | Q1 |
92549 | Cdp-sot 6 cond w/i&r mct&adt | Q1 | Q1 | Q1 |
92552 | Pure tone audiometry air | Q1 | Q1 | Q1 |
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