Audiology CPT Code Framework
Audiology billing relies on a set of diagnostic testing codes that are distinct from standard E/M visits. Most audiology services are billed as procedures rather than office visits, which means the coding structure centers on the specific tests performed rather than the complexity of medical decision-making. Getting the codes right determines whether the practice collects $85 for a basic screening or $350 or more for a comprehensive diagnostic evaluation. The difference comes down to documenting the right test, pairing it with the right diagnosis, and understanding which tests can be billed together on the same date of service.
Pure Tone Audiometry (92552-92557)
Pure tone audiometry is the foundation of audiology billing. Code 92552 covers pure tone audiometry for air conduction only, reimbursing at approximately $28. Code 92553 adds air and bone conduction testing, reimbursing at approximately $38. Code 92557 is the comprehensive audiometry code that includes air conduction, bone conduction, and speech recognition testing (SRT and word recognition), reimbursing at approximately $52. Most diagnostic evaluations should be billed as 92557 because a complete workup includes all three components.
A common billing error is reporting 92552 and 92553 on the same date of service. These codes are mutually exclusive because 92553 already includes the air conduction testing covered by 92552. Selecting 92557 when the full battery is performed captures the highest appropriate reimbursement in a single code rather than attempting to unbundle the components.
Tympanometry and Acoustic Reflex Testing (92567-92568)
Tympanometry (92567) assesses middle ear function by measuring tympanic membrane compliance, reimbursing at approximately $22. Acoustic reflex testing (92568) measures the stapedial reflex at various frequencies, reimbursing at approximately $28. These two codes are commonly billed together during a diagnostic evaluation because they provide complementary information about middle ear status. Tympanometry identifies effusion, perforation, or eustachian tube dysfunction, while acoustic reflex testing helps differentiate cochlear from retrocochlear pathology.
Both 92567 and 92568 can be billed alongside 92557 on the same visit without bundling issues. A standard diagnostic audiology appointment that includes comprehensive audiometry, tympanometry, and acoustic reflex testing generates approximately $102 in procedure charges before any additional tests.
Auditory Brainstem Response (92585)
ABR testing (92585) measures neural responses along the auditory pathway from the cochlea through the brainstem. This code reimburses at approximately $115 and is used for threshold estimation in patients who cannot provide reliable behavioral responses (infants, young children, cognitively impaired individuals) and for retrocochlear assessment when acoustic neuroma or other neural pathology is suspected. ABR is typically ordered by a physician, and many payers require documentation of the medical necessity for the test, including the specific clinical question being answered.
ABR should not be billed routinely with every diagnostic evaluation. It is medically necessary when behavioral results are unreliable or inconsistent, when asymmetric hearing loss requires retrocochlear rule-out, or when newborn hearing screening results need confirmation. Payers will deny ABR claims that lack supporting documentation of medical necessity.
Otoacoustic Emissions (92558)
OAE testing (92558) measures sounds generated by the outer hair cells of the cochlea, reimbursing at approximately $48. OAE is used for hearing screening (particularly newborn screening programs), cochlear function assessment, and monitoring ototoxic medication effects. The test is objective, requiring no behavioral response from the patient, making it valuable for pediatric populations and patients who cannot participate in standard audiometry.
OAE and ABR are both objective tests but measure different aspects of auditory function. OAE evaluates outer hair cell function (cochlear), while ABR evaluates neural transmission (retrocochlear). Billing both on the same date of service is appropriate when the clinical question requires both cochlear and neural assessment, but documentation must support the medical necessity for each test independently.
Hearing Aid Evaluation and Fitting (92590-92595)
Hearing aid evaluation codes cover the assessment and fitting process. Code 92590 is the hearing aid examination and selection for each ear, reimbursing at approximately $42. Code 92591 covers hearing aid check and reprogramming, approximately $35. Code 92592 is the hearing aid fitting for one ear (monaural), approximately $55, and 92593 is the binaural fitting, approximately $75. Code 92594 covers electroacoustic evaluation for hearing aid check (monaural) at approximately $35, and 92595 is the binaural version at approximately $45.
Medicare does not cover hearing aids or routine hearing aid evaluations. However, Medicare Part B does cover diagnostic audiometry when ordered by a physician to evaluate a medical condition. The distinction between diagnostic testing (covered) and hearing aid related services (not covered) is the most important billing boundary in audiology. Practices must clearly separate diagnostic claims from hearing aid related services to avoid Medicare denials and compliance risk.