Find policies, billing codes, payers, states, and providers

CPT 92542: Positional Nystagmus Recording (ENG/VNG)

CPT code 92542 represents positional nystagmus testing using electronystagmography (ENG) or infrared videonystagmography (VNG) to record rapid eye movements when a patient changes head position. This diagnostic procedure is an important tool nationally for evaluating vestibular dysfunction, dizziness, and balance disorders, providing objective data that can influence diagnostic pathways and subsequent management.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis addresses coverage patterns and reimbursement benchmarks for these major payers and summarizes clinical and billing contexts relevant to practitioners who perform vestibular testing.

Readers will find a concise overview of what CPT code 92542 covers, typical sites of service where the test is performed, and the clinical significance of positional nystagmus recording. The publication also outlines expected benchmarks and payer coverage considerations, highlights any recent policy updates when available, and places the code in clinical context for audiologists, otolaryngologists, and neurologists. Data not available in the input is noted where applicable.

Customize your policy alerts

Sign up for cpt 92542 policy alerts

Get alerted when payer policies referencing 92542 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

CPT code 92542 documents the use of electronystagmography or infrared videonystagmography electrodes to measure and record rapid eye movements (nystagmus) that occur when a patient changes head position. This test captures objective eye movement responses to positional changes to help evaluate vestibular and balance disorders.

Service Type: Diagnostic vestibular testing (positional nystagmus recording)

Typical Site of Service: Audiology clinic, otolaryngology clinic, neurology clinic, or hospital outpatient diagnostic unit

Find policies, billing codes, payers, states, and providers

CPT 92542: Positional Nystagmus Recording (ENG/VNG)

Customize your policy alerts

Sign up for cpt 92542 policy alerts

Get alerted when payer policies referencing 92542 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

Service Type: Diagnostic vestibular testing (positional nystagmus recording)

Typical Site of Service: Audiology clinic, otolaryngology clinic, neurology clinic, or hospital outpatient diagnostic unit

Clinical & Coding Specifications

Clinical Context

A 54-year-old patient presents to an outpatient neurotology clinic with a 6-week history of episodic vertigo, unsteadiness with head movement, and intermittent nausea. The clinician performs a focused history and physical exam, including bedside ocular motility and vestibular testing, and schedules quantitative positional vestibular testing using videonystagmography/electronystagmography to record eye movements during head position changes. The patient is seated in a dedicated testing room; surface electrodes or an infrared video camera are placed to capture horizontal and vertical eye movements. The technologist guides a series of positional maneuvers (supine roll, Dix–Hallpike, head-hanging, and head turns) while the system records nystagmus velocity and direction. The provider reviews the tracings, documents test findings (direction-fixed or direction-changing nystagmus, latency, duration, fatigability), and integrates results with clinical exam to support diagnoses such as benign paroxysmal positional vertigo or central positional nystagmus. Billing is submitted for 92542 for the objective recording of eye movements during positional testing. Typical sites of service include outpatient specialty clinics (neurotology, otolaryngology), hospital outpatient departments, and ambulatory diagnostic centers.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure	Use when an E/M visit is medically necessary and distinct from the diagnostic testing on the same day.
`26`	Professional component	Use when billing only the physician interpretation/report for the test and the technical component is billed separately.
`TC`	Technical component	Use when billing only the technical component (equipment, technician) for the test.
`59`	Distinct procedural service	Use when positional VNG/ENG is distinct from another procedure on the same day not normally billed together.
`52`	Reduced services	Use when the test is partially performed or abbreviated and not fully completed.
`53`	Discontinued procedure	Use when testing is started but discontinued for patient safety or intolerance.
`76`	Repeat procedure by same physician (note: `76` not in provided list; excluded)	Data not available in the input.
`78`	Unplanned return to operating/procedure room by same physician following initial procedure for a related procedure during the postoperative period	Rarely applicable; use only if an unplanned return to the procedure area occurs related to testing.
`80`	Assistant surgeon	Generally not applicable to this diagnostic test; included in modifiers list but seldom used for `92542`.
`22`	Increased procedural services	Use when the test requires substantially greater work than typical (document reasons).
`59`	Distinct procedural service	Duplicate entry removed; see above.
`51`	Multiple procedures	Use when multiple procedures are billed on the same day; may affect payment.
`27`	Multiple outpatient hospital settings	Use when services are provided across multiple outpatient hospital settings on the same day.

Taxonomy Code	Specialty	Notes
208C00000X	Otolaryngology (ENT)	Common specialty performing vestibular function testing and interpretation.
207K00000X	Neurology	Neurologists evaluate central causes of positional nystagmus and perform or interpret testing.
2080P0208X	Audiology	Audiologists or vestibular technologists often perform the technical component of testing.
208D00000X	Physical Medicine & Rehabilitation	Clinicians may order and interpret vestibular testing in balance disorder management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H81.11`	Benign paroxysmal vertigo, right ear	Positional testing with `92542` documents nystagmus patterns consistent with BPPV on the affected side.
`H81.12`	Benign paroxysmal vertigo, left ear	Same as above for left-sided BPPV; positional recordings help localize affected canal.
`H81.13`	Benign paroxysmal vertigo, bilateral	Used when positional testing reveals bilateral positional nystagmus.
`H81.8`	Other disorders of vestibular function	Positional ENG/VNG assists in characterizing atypical vestibular presentations.
`R42`	Dizziness and giddiness	A common presenting symptom prompting positional VNG/ENG; helps differentiate peripheral vs central causes.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`92541`	Electronystagmography, positional testing; without recording	Performed when bedside positional testing is documented without objective electronic recording; `92542` is the recorded equivalent.
`92543`	Electronystagmography, positional testing; recording, bithermal caloric stimulation not included	Complements `92542` when additional ENG/VNG recordings include positional testing plus other vestibular tests; may be part of a test battery.
`92544`	Electronystagmography, positional testing; recording, positional nystagmus only	Used for focused recorded positional nystagmus testing; may be billed when only positional recordings are performed.
`92557`	Comprehensive vestibular function testing (caloric, rotation, positional, etc.)	Represents a broader vestibular battery that may include `92542` as part of a complete evaluation.
`92601`	Diagnostic analysis of vestibular function testing; interpretation and report	Used for formal interpretation and reporting of vestibular test results, often billed with `92542` when interpretation is separately reportable.

Related Codes

CPT-92537-CALORIC-VESTIBULAR-TEST

CPT 92537: Caloric Vestibular Test, Qualitative Assessment

CPT-92538-CALORIC-VESTIBULAR-TEST-MONOTHERMAL

CPT 92538: Caloric Vestibular Test (Monothermal)

CPT-92540-VESTIBULAR-BALANCE-TESTING-FOUR-TESTS-WITH-RECORDING

CPT 92540: Vestibular and Balance Testing, Four Tests with Recording

CPT-92541-ELECTRONYSTAGMOGRAPHY-VIDEONYSTAGMOGRAPHY-EYE-MOVEMENTS

CPT 92541: Electronystagmography / Videonystagmography Eye Movement Recording

CPT-92544-OCULAR-MOTILITY-EYE-MOVEMENT-TESTING

CPT 92544: Ocular Motility and Bidirectional Eye Movement Testing

CPT-92545-VESTIBULAR-VISUAL-TRACKING-ASSESSMENT

CPT 92545: Vestibular Visual Tracking and Foveal Fixation Assessment

CPT-92546-VESTIBULAR-FUNCTION-SINUSOIDAL-ROTATION-TESTING

CPT 92546: Vestibular Function Testing with Sinusoidal Vertical–Axis Rotation

CPT-92547-VESTIBULAR-FUNCTION-TEST-VERTICAL-ELECTRODE-NYSTAGMUS

CPT 92547: Vestibular Function Test with Vertical Electrode Recording

CPT-92548-COMPUTERIZED-DYNAMIC-POSTUROGRAPHY-SENSORY-TESTING

CPT 92548: Computerized Dynamic Posturography Sensory Organization Testing

CPT-92549-COMPUTERIZED-DYNAMIC-POSTUROGRAPHY-BALANCE-TESTING

CPT 92549: Computerized Dynamic Posturography Sensory Organization Testing

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure	Use when an E/M visit is medically necessary and distinct from the diagnostic testing on the same day.
`26`	Professional component	Use when billing only the physician interpretation/report for the test and the technical component is billed separately.
`TC`	Technical component	Use when billing only the technical component (equipment, technician) for the test.
`59`	Distinct procedural service	Use when positional VNG/ENG is distinct from another procedure on the same day not normally billed together.
`52`	Reduced services	Use when the test is partially performed or abbreviated and not fully completed.
`53`	Discontinued procedure	Use when testing is started but discontinued for patient safety or intolerance.
`76`	Repeat procedure by same physician (note: `76` not in provided list; excluded)	Data not available in the input.
`78`	Unplanned return to operating/procedure room by same physician following initial procedure for a related procedure during the postoperative period	Rarely applicable; use only if an unplanned return to the procedure area occurs related to testing.
`80`	Assistant surgeon	Generally not applicable to this diagnostic test; included in modifiers list but seldom used for `92542`.
`22`	Increased procedural services	Use when the test requires substantially greater work than typical (document reasons).
`59`	Distinct procedural service	Duplicate entry removed; see above.
`51`	Multiple procedures	Use when multiple procedures are billed on the same day; may affect payment.
`27`	Multiple outpatient hospital settings	Use when services are provided across multiple outpatient hospital settings on the same day.

Taxonomy Code	Specialty	Notes
208C00000X	Otolaryngology (ENT)	Common specialty performing vestibular function testing and interpretation.
207K00000X	Neurology	Neurologists evaluate central causes of positional nystagmus and perform or interpret testing.
2080P0208X	Audiology	Audiologists or vestibular technologists often perform the technical component of testing.
208D00000X	Physical Medicine & Rehabilitation	Clinicians may order and interpret vestibular testing in balance disorder management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H81.11`	Benign paroxysmal vertigo, right ear	Positional testing with `92542` documents nystagmus patterns consistent with BPPV on the affected side.
`H81.12`	Benign paroxysmal vertigo, left ear	Same as above for left-sided BPPV; positional recordings help localize affected canal.
`H81.13`	Benign paroxysmal vertigo, bilateral	Used when positional testing reveals bilateral positional nystagmus.
`H81.8`	Other disorders of vestibular function	Positional ENG/VNG assists in characterizing atypical vestibular presentations.
`R42`	Dizziness and giddiness	A common presenting symptom prompting positional VNG/ENG; helps differentiate peripheral vs central causes.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`92541`	Electronystagmography, positional testing; without recording	Performed when bedside positional testing is documented without objective electronic recording; `92542` is the recorded equivalent.
`92543`	Electronystagmography, positional testing; recording, bithermal caloric stimulation not included	Complements `92542` when additional ENG/VNG recordings include positional testing plus other vestibular tests; may be part of a test battery.
`92544`	Electronystagmography, positional testing; recording, positional nystagmus only	Used for focused recorded positional nystagmus testing; may be billed when only positional recordings are performed.
`92557`	Comprehensive vestibular function testing (caloric, rotation, positional, etc.)	Represents a broader vestibular battery that may include `92542` as part of a complete evaluation.
`92601`	Diagnostic analysis of vestibular function testing; interpretation and report	Used for formal interpretation and reporting of vestibular test results, often billed with `92542` when interpretation is separately reportable.

Related Codes

CPT-92537-CALORIC-VESTIBULAR-TEST

CPT 92537: Caloric Vestibular Test, Qualitative Assessment

CPT-92538-CALORIC-VESTIBULAR-TEST-MONOTHERMAL

CPT 92538: Caloric Vestibular Test (Monothermal)

CPT-92540-VESTIBULAR-BALANCE-TESTING-FOUR-TESTS-WITH-RECORDING

CPT 92540: Vestibular and Balance Testing, Four Tests with Recording

CPT-92541-ELECTRONYSTAGMOGRAPHY-VIDEONYSTAGMOGRAPHY-EYE-MOVEMENTS

CPT 92541: Electronystagmography / Videonystagmography Eye Movement Recording

CPT-92544-OCULAR-MOTILITY-EYE-MOVEMENT-TESTING

CPT 92544: Ocular Motility and Bidirectional Eye Movement Testing

CPT-92545-VESTIBULAR-VISUAL-TRACKING-ASSESSMENT

CPT 92545: Vestibular Visual Tracking and Foveal Fixation Assessment

CPT-92546-VESTIBULAR-FUNCTION-SINUSOIDAL-ROTATION-TESTING

CPT 92546: Vestibular Function Testing with Sinusoidal Vertical–Axis Rotation

CPT-92547-VESTIBULAR-FUNCTION-TEST-VERTICAL-ELECTRODE-NYSTAGMUS

CPT 92547: Vestibular Function Test with Vertical Electrode Recording

CPT-92548-COMPUTERIZED-DYNAMIC-POSTUROGRAPHY-SENSORY-TESTING

CPT 92548: Computerized Dynamic Posturography Sensory Organization Testing

CPT-92549-COMPUTERIZED-DYNAMIC-POSTUROGRAPHY-BALANCE-TESTING

CPT 92549: Computerized Dynamic Posturography Sensory Organization Testing

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 92542: Positional Nystagmus Recording (ENG/VNG)

Sign up for cpt 92542 policy alerts

Billing Code Overview

Catch payer policy changes before they impact reimbursement

Catch payer policy changes before they impact reimbursement

OpenPayer

CPT 92542: Positional Nystagmus Recording (ENG/VNG)

Sign up for cpt 92542 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References