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).