Question
What is the CPT code for a tinnitus masker? What is the likelihood that an insurance company will pay for one?
Answer
The CPT code for tinnitus masker is 92599 (unspecified otolaryngologic procedure). We use this code as a ''catch-all'' code for equipment, batteries, accessories, hearing aids, and other ''hardware''. It doesn't matter what kind of masker it is, the code is still 92599. Some audiologists use a suffix with the code: 92599-06 is ''Sound generator: Monaural'' and 92599-07 is ''Sound generator: Binaural.'' However, these are local codes that often mean nothing to most insurance companies. Their computers will look at the ''92599'' part of the code only as an unspecified otolaryngologic procedure without reference to anything else. Conceivably, the audiologist should be able to bill a fitting and dispensing under 92590 (Hearing aid examination and selection, monaural) for one unit or 92591 (Hearing aid examination and selection, binaural) for two units. This would be on the basis that the work to fit and dispense a masker is very similar to that of a hearing aid in many respects. If the unit were a combination hearing aid and masker, then one could certainly use either of those codes depending on monaural or binaural dispensing. Any earmold to hold the unit in place would also be processed under code 92599.
The second part of the question - will insurance companies pay, can be cautiously answered ''yes'' in many cases. As always, pre-approval from the insurance carrier in each individual case is critical. In addition, a report must be submitted with the claim to illustrate to the insurance company what the procedure did (since 92599 is ''unspecified'') and that it was commensurate with their approval.
Bio:
Robert C. Fifer, Ph.D., is currently the Director of Audiology and Speech-Language Pathology at the Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine. He originally served as the representative of the American Academy of Audiology in the submission and revision of audiology CPT codes in 1995. Since then, with the exception of one year, he has worked as a member of the coding committee for the American Speech-Language-Hearing Association. He also serves as a consultant to state agencies in Florida regarding audiology coding issues.
