Summary & Overview
CPT 69633: Tympanic Membrane and Ossicular Reconstruction with Prosthesis
CPT code 69633 represents an otologic reconstructive operation that combines tympanic membrane repair (tympanoplasty) with ossicular chain reconstruction using a synthetic prosthesis. This procedure addresses conductive hearing loss due to tympanic membrane perforation and ossicular disruption and is performed in an operating room setting without mastoid cavity removal. Nationally, this code matters because it captures a distinct combined reconstructive service that influences surgical resource use, specialty reimbursement patterns, and quality measurement in ear surgery.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when CPT code 69633 is used, typical sites of service, and how the code differs from isolated tympanoplasty or ossicular procedures. The publication covers billing and policy considerations relevant to payers and provider organizations, benchmarks for frequency and utilization where available, and recent policy updates or documentation expectations that affect claim adjudication. Practical information on common modifiers and related coding considerations is included to help coding professionals and administrators ensure accurate claim submission.
Data not available in the input for specific ICD-10 pairings, payer-specific rates, and associated taxonomies are noted where applicable.
Billing Code Overview
CPT code 69633 describes a surgical procedure in which the provider reconstructs the tympanic membrane (eardrum) to repair a perforation and reconstructs the ossicular chain to improve conductive hearing. The procedure includes placement of a synthetic ossicular prosthesis and may involve reconstruction of the ear canal and an attic tympanotomy or other middle ear surgeries. The description specifies that removal of the mastoid cavity is not included.
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Service type: Middle ear reconstructive surgery combining tympanoplasty and ossiculoplasty with prosthesis placement
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Typical site of service: Inpatient or outpatient surgical setting (operating room) for otologic surgery
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient presents with chronic conductive hearing loss and a persistent central tympanic membrane perforation after prior otitis media. Preoperative audiometry demonstrates an air-bone gap of 25 dB in the affected ear. The surgeon plans a tympanoplasty with ossicular chain reconstruction and placement of a partial or total ossicular replacement prosthesis to restore continuity of the ossicular chain and improve conductive hearing. The clinical workflow includes: preoperative evaluation (history, otoscopy, audiogram, CT temporal bones as indicated), informed consent, general anesthesia in an operating room or ambulatory surgery center, microscope-assisted transcanal or postauricular tympanoplasty with ossiculoplasty and prosthesis placement, intraoperative documentation of perforation size and ossicular status, immediate postoperative recovery with ear dressing, postoperative audiogram at 6–12 weeks, and routine follow-up visits to assess graft take, prosthesis position, and hearing improvement. Typical indications include traumatic or chronic tympanic membrane perforation with ossicular discontinuity or fixation. Typical contraindications include active uncontrolled middle ear infection. Typical site of service is an operating room in a hospital or an ambulatory surgery center.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier used (historic placeholder) | Rarely used; not applied in contemporary billing workflows for this procedure |