Billing for Cerumen Removal

Question

Answer

CPT code 69210 is used by physicians to code cerumen management when performed as a separate procedure. When performed as part of a physical exam, cerumen management is not coded separately. Audiologists are not reimbursed for treatment services under Medicare. This has to do with peculiar language in the Social Security Act that limits reimbursement to audiologists for diagnostic assessment services only. In a July 15 letter to the President of the American Academy of Audiology, CMS provided the following opinion.

''The Medicare program includes a benefit for diagnostic audiology testing. It requires that a physician refer the patient to an audiologist. CMS presumes that a physician would not make a referral to an audiologist prior to examination of the patient by the physician. If the physician identifies impacted cerumen, the physician would remove it to confirm that it is not responsible for the hearing defect. Since the physician would remove impacted cerumen prior to referral to an audiologist, there would be no circumstances under the Medicare program when an audiologist would remove impacted cerumen.''

This opinion was written by Dr. Niles Rosen, Medical Director of the National Correct Coding Initiative.

Kyle C. Dennis, Ph.D. CCC-A, FAAA

The opinions expressed herein are solely those of the authors and do not reflect the views or official policies of the United States Government or the Department of Veterans Affairs.

BIO: Dr. Dennis is a board certified audiologist with 26 years of experience. Dr. Dennis has extensive experience in coding, documentation, and reimbursement and serves on the Reimbursement Committee of the American Academy of Audiology. Dr. Dennis is currently the Deputy Director, Audiology and Speech Pathology Service in the U.S. Department of Veterans Affairs in Washington D.C. Dr. Dennis is a member of the Board of Directors for Audiology Online.