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TRICARE Policy Manual 6010.60-M, April 1, 2015
Medicine
Chapter 7
Section 8.1
Special Otorhinolaryngologic Services
Issue Date:  April 19, 1983
Authority:  32 CFR 199.4(c)(3)(iv), (g)(47), 32 CFR 199.5(c), and 10 USC 1079(e)
Copyright:  CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Revision:  
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).
4.0  Exclusion
Uvulopalatopharyngoplasty (UPPP) (CPT procedure code 42145) for the treatment of Upper Airway Resistance Syndrome (UARS) is unproven.
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