Summary & Overview
CPT 92565: Binaural Tone Comparison for Unilateral Hearing Loss
CPT code 92565 represents a specific audiologic diagnostic procedure that delivers identical-frequency tones to both ears simultaneously to identify unilateral hearing loss or pseudohypacusis. This targeted test helps clinicians and payers distinguish true asymmetric sensorineural or conductive loss from nonorganic or exaggerated hearing complaints, which has implications for clinical management and utilization oversight nationwide. Key payers examined in coverage and reimbursement discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical intent and typical settings for CPT code 92565, plus comparative viewpoints on payer coverage approaches, common billing modifiers, and where this service fits within audiology service lines. The publication outlines benchmarking context and policy considerations relevant to national stakeholders, and it provides practical detail on coding nomenclature and service characterization for billing, compliance, and clinical documentation workflows. Data not available in the input for payer-specific rates, utilization benchmarks, associated taxonomies, and ICD-10 pairing are noted where relevant.
Billing Code Overview
CPT code 92565 describes a clinical auditory test in which the provider delivers two tones of the same frequency simultaneously to both ears to detect unilateral hearing loss or pseudohypacusis (nonorganic hearing loss). This procedure is an objective binaural tone comparison used to assess whether reported hearing loss is genuine or exaggerated.
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Service type: Diagnostic audiologic test
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Typical site of service: Audiology clinic or outpatient otolaryngology practice
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient presents to an otolaryngology or audiology clinic reporting one-sided hearing difficulty after a history of recurrent otitis media and recent head trauma. The provider suspects either true unilateral sensorineural/conductive hearing loss or nonorganic (pseudohypacusis) responses. The clinic visit includes a focused history, otoscopic exam, and tuning-fork tests as indicated. Audiometric evaluation is ordered and includes behavioral pure-tone audiometry and objective cross-check tests. During the audiology session, the clinician administers the test described by 92565, delivering two tones of the same frequency simultaneously to both ears (stenger-type tone presentation) to determine whether responses are consistent with unilateral hearing loss or suggest pseudohypacusis. Results guide next steps: if unilateral hearing loss is confirmed, diagnostic audiometry and imaging or ENT referral may follow; if results indicate nonorganic hearing loss, counseling and further assessment are documented. Typical site of service is an outpatient audiology clinic, otolaryngology office, or hospital outpatient department. The typical clinician performing this procedure is an audiologist or ENT physician with audiology staff support. Commonly applicable payors encountered for claims include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal or E/M service by the same physician during postoperative period |