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 | Used when no special modifier is applicable for the service. |
22 | Increased procedural services | Use when the evaluation required substantially greater work than typical (document justification). |
23 | Unusual anesthesia | Not commonly used for this outpatient audiology evaluation; report only if unusual anesthesia was required. |
51 | Multiple procedures | Use when multiple distinct procedures are billed on the same day by the same provider, as applicable. |
52 | Reduced services | Use when the audiologic evaluation is partially reduced or not completed as originally described. |
53 | Discontinued procedure | Use if testing was started but discontinued for patient safety or other acceptable reason. |
62 | Two surgeons | Rare for this diagnostic procedure; use only if two qualified providers share responsibility per payer rules. |
78 | Unplanned return to OR | Not applicable in routine audiometry; included only if event-driven surgical return occurs. |
80 | Assistant surgeon | Not typically applicable; use if an assistant surgeon is involved per payer policy. |
82 | Assistant not available | Use when assistant surgeon services are required but a qualified assistant is not available. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services | Use when a PA/NP/CNS performs the evaluation and payer requires this modifier to identify non-physician practitioner billing. |
QX | Rendering physician/supplier modifier for assistant | Use when reporting services with a qualified assistant under specified arrangements per payer policy. |
QY | Attendance at procedure by physician assistant | Use when supervision/incident-to rules require identification of a PA’s involvement. |
TG | Technologist performing service under general supervision | Use when a registered technologist performs testing under the supervision of an audiologist or physician and payer requires the technologist modifier. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 261QM0800X | Otolaryngology | ENT physicians commonly interpret audiologic testing and manage medical-surgical ear conditions. |
| 261QC2400X | Audiology | Audiologists perform diagnostic audiometry, counseling, and hearing aid candidacy assessments. |
| 261QP2300X | Physician Assistant - Otolaryngology | PAs working in ENT practices often perform parts of the audiologic evaluation or coordinate testing. |
| 207RH0000X | Otology/Neurotology | Subspecialists evaluate complex sensorineural disorders that may arise from testing. |
| 261QM0800X-EXT | Primary care referral source | Primary care providers refer patients for diagnostic audiologic evaluations (listed for workflow context). |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
H90.3 | Sensorineural hearing loss, bilateral | Common indication for comprehensive air and bone conduction testing to quantify sensorineural loss and assess hearing aid candidacy. |
H90.41 | Unilateral hearing loss, right ear, conductive | Air and bone conduction testing determines conductive component and degree, guiding medical vs audiologic management. |
H90.42 | Unilateral hearing loss, left ear, conductive | Same clinical relevance for the left ear; helps identify middle ear pathology vs cochlear involvement. |
H91.90 | Unspecified hearing loss, unspecified ear | Used when initial evaluation documents hearing loss but further specification is pending diagnostic test results. |
H93.13 | Tinnitus, bilateral | Frequently co-reported with hearing loss; evaluation includes audiometry to identify associated hearing threshold abnormalities. |
Z01.10 | Encounter for examination of ears and hearing without abnormal findings | May be used for baseline or screening encounters when testing reveals no clinically significant hearing impairment. |
H90.5 | Mixed conductive and sensorineural hearing loss | Pure-tone air and bone conduction testing is essential to identify mixed pathologies and plan management. |
H83.3 | Central hearing loss | When testing suggests auditory processing or central auditory involvement, further specialized assessment is indicated. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
92557 | Comprehensive audiometry threshold evaluation including speech recognition | Often performed in conjunction with or as an alternative to this detailed evaluation; overlaps with threshold and speech testing components. |
92567 | Tympanometry (impedance testing) and reflex threshold measurements | Frequently performed before or during audiologic assessment to evaluate middle ear function and help differentiate conductive vs sensorineural loss. |
92562 | Conditioning play or visual reinforcement audiometry (behavioral pediatric testing) | Alternative testing methods for pediatric patients who cannot reliably complete standard air/bone and speech tests. |
92626 | Evaluation of auditory rehabilitation status, first hour (e.g., hearing aid assessment) | Used when formal hearing aid candidacy evaluation and counseling are provided following diagnostic testing. |
92601 | Diagnostic analysis of cochlear implant, preoperative assessment | Performed in specialized workflows when severe-profound sensorineural hearing loss is identified and implant candidacy is considered. |
92552 | Pure tone audiometry (threshold) air only | May be billed for limited threshold testing when bone conduction or speech testing is not performed or indicated. |