OAR 410-129-0240: Audiologist and Hearing Aid Procedure Codes

(1) Inclusion of a CPT/HCPCS code on the following does not mean that a code is covered. Refer to OAR 410-120-1280 and OAR 410-141-3565 for information on coverage. (2) The following are Audiologist and hearing aid procedure codes: (a) 92553 – Pure tone audiometry, air and bone, limited to one per calendar year; (b) 92557 – Comprehensive audiometry threshold evaluation and speech recognition includes pure tone, air and bone, and speech threshold and discrimination. Also includes testing necessary to determine feasibility of amplification; (c) 92590 – Hearing aid examination and selection, monaural may include sound field speech reception tests, speech discrimination tests, determination of appropriate style of hearing aid and to determine if the ear may receive amplification; (d) 92591 – Hearing aid examination and selection, binaural may include sound field speech reception tests, speech discrimination tests, determination of appropriate style of hearing aid, and which ear may receive amplification; (e) 92592 – Monaural hearing aid inspection and battery check. The aid is cleaned, and the power and clarity are checked using a special stethoscope, which attaches to the hearing aid. (f) 92593 – Binaural hearing aids inspection and battery check. The aids are cleaned, and the power and clarity are checked using a special stethoscope, which attaches to the hearing aids. (g) V5261 – Hearing aid, digital, binaural and behind the ear requires Prior Authorization (PA); (h) V5011 – Fitting, orientation, checking of hearing aid includes adjusting aid to the wearer, instructions to wearer, and follow-up care, and requires PA prior to provision of services; (i) V5275 – Ear impressions made to obtain a hearing device specified for the individual, each. (j) V5160 – Hearing aid dispensing fee, binaural, requires PA prior to providing services; (k) V5181 – Hearing aid, contralateral routing device, monaural, behind the ear (bte); (L) V5200 – Hearing aid dispensing fee, contralateral, monaural, requires PA prior to providing services; (m) V5240 – Hearing aid dispensing fee, two devises, contralateral routing system, binaural, requires PA prior to providing services; (n) V5241 – Hearing aid dispensing fee, monaural hearing aid, any type, requires PA prior to providing services; (o) V5110 – Body warn hearing aid dispensing fee, bilateral. (p) V5020 – The conformity evaluation is to confirm that the hearing aid is meeting the needs of the patient. (q) 95992 – Canalith repositioning, treatment for vertigo, per day. (3) Special otorhinolaryngologic services codes only apply to services for cochlear implants. These services include medical diagnosis evaluation by the otology physician: (a) 92601 – Diagnostic analysis of cochlear implant, patient under seven (7) years of age, with programming; (b) 92602 – Analysis and reprogramming of inner ear (cochlear) implant, younger than seven 7 years of age; (c) 92603 – Diagnostic analysis of cochlear implant, age seven (7) years or older, with programming; follow up exam; (d) 92604 – Analysis and reprogramming of inner ear (cochlear) implant, age seven 7 years or older; (e) 92626 – Evaluation of auditory rehabilitation status, first hour; (f) 92627 – Each additional 15 minutes; (g) 92630 – Auditory rehabilitation; pre-lingual hearing loss; (h) 92633 – Post-lingual hearing loss; (i) L8614 – Cochlear device/system (only reimbursed to hospitals); (j) L8615 – Headset/headpiece for use with cochlear implant device, replacement; (k) L8616 – Microphone for use with cochlear implant device, replacement; (L) L8617 – Transmitting coil for use with cochlear implant device, replacement; (m) L8618 – Transmitter cable for use with cochlear implant device, replacement; (n) L8619 – Cochlear implant external speech processor, replacement; (o) L8621 – Zinc air battery for use with cochlear implant device, replacement, each (maximum of 420 batteries per 12 months); (p) L8622 - Alkaline battery for use with cochlear implant device, replacement, each (maximum of 420 batteries per 12 months); (q) L8623 – Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each (maximum of two rechargeable per 12 months); (r) L8624 –Lithium ion battery for use with cochlear implant device speech processor, ear level, replacement, each (maximum of two rechargeable per 12 months); (s) L7510 – Repair of prosthetic device, repair or replace minor parts, requires PA prior to providing services; (t) L7520 – Repair prosthetic device, labor component, for 15 minutes, requires PA prior to providing services.