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).