Summary & Overview
CPT 92552: Pure Tone Audiometry Threshold Assessment
CPT code 92552 denotes pure tone audiometry threshold testing, a foundational diagnostic procedure that measures the lowest sound levels a patient can detect across frequencies. Nationally, this test underpins audiologic diagnosis, hearing aid candidacy assessments, occupational hearing surveillance, and pre- and post-treatment evaluations. It is commonly performed in outpatient audiology or otolaryngology settings and by licensed audiologists.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of coding intent and clinical context, typical sites of service, common modifiers relevant to billing, and an outline of payer coverage patterns. The publication highlights benchmarks for utilization and reimbursement where available, describes billing and documentation considerations, and summarizes recent policy updates that affect claim adjudication for diagnostic audiology services.
The content is designed for clinicians, billing professionals, and policy analysts seeking a national-level reference on billing, coding accuracy, and payer interactions for pure tone audiometry represented by CPT code 92552. Data not included in the input are noted explicitly.
Billing Code Overview
CPT code 92552 describes pure tone audiometry testing to determine the softest levels at which a patient perceives tones at multiple frequencies. This assessment identifies hearing thresholds and documents auditory function using a series of tones at varying intensities.
-
Service type: Diagnostic audiology testing (pure tone threshold assessment)
-
Typical site of service: Outpatient audiology clinic, otolaryngology clinic, hospital outpatient department, or dedicated hearing center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical adult patient presents to an outpatient audiology or otolaryngology clinic reporting progressive difficulty hearing conversations, especially in noisy environments, over several months. The provider documents a focused history including onset, asymmetry, prior noise exposure, ototoxic medication use, tinnitus, and ear pain. Physical exam includes otoscopy to inspect the external canal and tympanic membrane. The clinician performs pure-tone audiometry (92552) in a sound-treated booth using calibrated audiometric equipment to determine air-conduction thresholds across standard frequencies and identify the softest levels the patient can detect. Test results guide further testing (speech audiometry, bone conduction, tympanometry) or management (hearing aids, medical or surgical referral). Typical sites of service are outpatient audiology clinics, ENT offices, or hospital outpatient departments. The service type is diagnostic auditory threshold assessment (pure-tone air-conduction threshold testing).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service on the same day | Use when a distinct evaluation and management visit is performed in addition to the audiometric testing. |