1.0 CPT 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) codes 92601 and 92602),
and age seven years or older with programming (CPT 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 codes 92605-92609).
3.6 Audiologists are not authorized
to bill using Evaluation and Management (E/M) codes (CPT codes 99201-99499).