Summary & Overview
CPT 92568: Stapedius (Acoustic) Reflex Testing for Hearing Loss
CPT code 92568 denotes stapedius (acoustic) reflex testing: a diagnostic procedure that records contraction of the stapedius muscle in response to loud sound to help determine causes of hearing loss. This auditory reflex assessment is an important component of comprehensive audiologic and otologic evaluation because it helps distinguish conductive versus sensorineural mechanisms and can inform further diagnostic pathways and management decisions.
Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers can expect a concise review of the clinical context for the service, common sites where it is performed, and the payer coverage landscape. The publication outlines benchmark considerations for utilization and reimbursement, highlights coding and billing practice points relevant to this diagnostic service, and summarizes policy updates affecting coverage where available.
This summary serves clinicians, audiologists, billing professionals, and policy analysts seeking a national-level briefing on CPT code 92568, its clinical role in hearing loss evaluation, and the payer environment that shapes access and claims processing.
Billing Code Overview
CPT code 92568 measures the contraction of the stapedius muscle in response to loud sound to help determine the cause of hearing loss. This test evaluates middle-ear reflexes by recording stapedius muscle activity and assesses the integrity of the auditory reflex pathway.
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Service type: Diagnostic auditory reflex testing
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Typical site of service: Audiology clinic, otology clinic, or hospital outpatient department
Clinical & Coding Specifications
Clinical Context
A 54-year-old patient presents to an otolaryngology or audiology clinic with unilateral sensorineural hearing loss and intermittent aural fullness following a history of ototoxic medication exposure. The clinician performs an impedance-based assessment including acoustic reflex testing to evaluate middle-ear and auditory nerve pathway integrity. In a typical workflow the patient undergoes otoscopy and tympanometry first to assess middle-ear status. If tympanometry is within acceptable limits and ear canal is clear, the provider delivers loud pure tones via an earphone to elicit the stapedius muscle contraction while measuring reflex amplitude and latency using immittance equipment. Results help differentiate cochlear versus retrocochlear pathology and guide further testing such as pure-tone audiometry, speech audiometry, otoacoustic emissions, or auditory brainstem response testing. Documentation includes indication, ear tested, stimulus type and level, reflex thresholds, presence or absence of reflex decay, equipment used, and provider interpretation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the interpretation/reporting by the physician or audiologist separate from equipment and facility technical component. |
59 |