Summary & Overview
CPT 0212T: Audiologic Evaluation with Air and Bone Conduction and Speech Recognition
CPT code 0212T represents a comprehensive audiologic diagnostic evaluation that uses both air and bone conduction testing along with speech recognition measures to establish the type of hearing loss and assess candidacy for a hearing aid. This service is clinically important because accurate differentiation between sensorineural and conductive hearing loss guides treatment decisions, assistive-device planning, and appropriate referrals. Nationally, such evaluations are a core component of outpatient audiology and otolaryngology services and affect device utilization and care pathways for patients with hearing impairment.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how the code is defined, the expected service setting, and common billing modifiers; benchmark considerations and reimbursement patterns are summarized for major commercial payers and Medicare. The publication provides clinical context on the elements of the evaluation (air/bone conduction and speech recognition testing), typical sites of service, and implications for follow-up care such as hearing-aid assessment.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and specific payer pricing—those fields are noted as unavailable where applicable. The piece is intended to inform coding, billing, and clinical stakeholders about the service represented by CPT code 0212T and what to expect in payer coverage and clinical workflows.
Billing Code Overview
CPT code 0212T describes an audiologic evaluation that assesses hearing using both air conduction and bone conduction testing to determine the patient’s hearing threshold and measures of speech recognition (ability to recognize and repeat familiar words). The evaluation establishes the type of hearing loss and determines whether the patient would benefit from a hearing aid.
Service type: Audiologic diagnostic evaluation with air and bone conduction testing and speech recognition testing.
Typical site of service: Outpatient audiology clinic or ear, nose, and throat (ENT) office; may also be performed in hospital outpatient departments where audiology services are provided.
Clinical & Coding Specifications
Clinical Context
A 67-year-old patient is referred to an audiology clinic by their primary care physician for progressive difficulty understanding speech, particularly in noisy environments, and reports bilateral hearing loss for the past 2 years. The audiologist performs a comprehensive audiologic evaluation using both air and bone conduction pure-tone threshold testing and speech recognition testing to determine type (conductive, sensorineural, or mixed) and degree of hearing loss and to assess candidacy for amplification. The clinical workflow includes intake and history (otologic history, noise exposure, ototoxic medications), otoscopic exam, tympanometry as indicated, pure-tone air conduction testing at octave and inter-octave frequencies, bone conduction testing to establish air-bone gaps, and speech reception threshold (SRT) plus word recognition scores using recorded materials. Results are interpreted to establish whether the loss is conductive (air-bone gap present), sensorineural (no significant air-bone gap), or mixed, and the audiologist documents recommendations regarding hearing aid benefit and need for medical referral. Typical documentation includes test results, tympanometric and otoscopic findings, comparison to prior audiograms if available, and a clear statement of hearing aid candidacy or need for medical workup. Typical site of service is an outpatient audiology clinic or ENT specialty office equipped with sound-treated booth and calibrated audiometric instrumentation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard reporting |