Summary & Overview
CPT 92557: Diagnostic Audiologic Evaluation with Pure Tone and Speech Testing
CPT code 92557 represents a diagnostic audiologic evaluation that combines pure tone threshold testing with speech recognition assessment. It identifies the softest sound levels a patient can hear across frequencies and measures the ability to recognize and repeat familiar words, information that informs diagnosis, amplification decisions, and treatment planning. Nationally, this code is fundamental to audiology and ENT practice workflows and impacts coverage, clinical pathways, and device fitting for patients with hearing loss.
Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical service represented by the code, the typical sites where the service is delivered, common billing and coding considerations, and an overview of payer coverage patterns and benchmarks where available. The publication also summarizes relevant policy updates that affect utilization and documentation expectations, and it situates CPT code 92557 within related audiologic services to aid correct code selection and claim submission.
This executive summary is intended for clinicians, billing professionals, and policy analysts seeking a national perspective on how CPT code 92557 is used, reimbursed, and documented across major payers.
Billing Code Overview
CPT code 92557 describes a comprehensive hearing assessment in which the provider determines the softest level at which a patient can detect pure tones and evaluates the patient’s ability to recognize and repeat familiar words. This includes pure tone threshold testing across relevant frequencies and speech recognition testing using standardized word lists.
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Service type: Diagnostic audiologic evaluation combining pure tone threshold determination and speech recognition testing
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Typical site of service: Audiology clinic, otolaryngology (ENT) clinic, outpatient specialty center, or hospital outpatient department
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Clinical & Coding Specifications
Clinical Context
A 56-year-old patient presents to an outpatient audiology clinic complaining of progressive difficulty hearing conversations, especially in noisy environments, over several months. The patient has a history of noise exposure and requests evaluation to determine the degree and type of hearing loss. The clinical workflow for this encounter includes intake documentation of history, otoscopic inspection of the external auditory canals, and medical decision-making by an audiologist or otolaryngologist. Pure tone air- and bone-conduction threshold testing is performed using calibrated audiometric equipment to determine the softest audible levels across frequencies for each ear. Speech recognition testing using recorded or monitored live voice word lists is administered to measure the patient’s ability to recognize familiar words and to calculate percent correct word recognition scores. Results are reviewed with the patient, documented in the medical record, and used to guide recommendations for amplification, further diagnostic testing (such as tympanometry or diagnostic audiology), or referral to ENT for medical management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional component of the audiologic testing if the technical component is billed separately. |