1.0 CPT
PROCEDURE CODES
92502 - 92512, 92516, 92520,
92526, 92551 - 92597, 92601 - 92617, 92626, 92627, 92630, 92633, 92640,
92700
2.0 DESCRIPTION
2.1 Otolaryngology
is that branch of medicine concerned with the screening, diagnosis
and management of medical and surgical disorders of the ear, the
upper respiratory and upper alimentary systems and related structures
and the head and neck.
2.2 Audiology is the discipline
involved in the prevention, identification and the evaluation of hearing
disorders, the selection and evaluation of hearing aids, and the
rehabilitation of individuals with hearing impairment. Audiological
services, including function tests, performed to provide medical diagnosis
and treatment of the auditory system.
3.0 POLICY
3.1 Otorhinolaryngology
services, including audiological services are covered for the diagnosis and
treatment of a covered medical condition.
3.2 Prior to September 1, 2005,
hearing aid services and supplies may be cost-shared only for eligible
beneficiaries through the Program for Persons with Disabilities
(PFPWD) on the basis of a hearing disability or of multiple disabilities,
one of which involves a hearing disability.
3.3 On or after
September 1, 2005, hearing aid services and supplies may be cost-shared
only for Active Duty Family Members (ADFMs) with a profound hearing
loss through the TRICARE Basic Program. See
Section 8.2.
3.4 Diagnostic
analysis of cochlear implant with programming is covered for patients
under seven years of age (Current Procedural Terminology (CPT) procedure
codes 92601 and 92602), and age seven years or older with programming
(CPT procedure codes 92603 and 92604). See
Chapter 4, Section 22.2.
3.5 Evaluation
for prescription of non-speech-generating augmentative and alternative communication
device, including programming and modification, may be cost-shared
only for eligible beneficiaries through the Extended Care Health
Option (ECHO) on the basis of a speech disability or of multiple
disabilities, one of which involves a speech disability (CPT procedure
codes 92605 - 92609).
3.6 Audiologists are not authorized
to bill using Evaluation and Management (E/M) codes (CPT procedure
codes 99201 - 99499).