Summary & Overview
CPT 92579: Pediatric Audiologic Assessment for Infants and Toddlers
CPT code 92579 identifies a pediatric audiologic assessment performed to evaluate hearing loss in infants and toddlers using sound sources and reinforced behavioral techniques such as animated toys. This code captures a specialized diagnostic service that is essential for early detection of hearing impairment, which has significant implications for language development, educational planning, and early intervention services nationwide. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what CPT code 92579 represents clinically and operationally, where the service is typically delivered, and the national context for its use. The publication summarizes common billing considerations, typical sites of service, and the clinical rationale for performing this pediatric-focused assessment. It also highlights available benchmarks and policy-relevant topics affecting coverage and coding practice. Data not available in the input: specific payer reimbursement rates, associated taxonomies, and ICD-10 diagnosis mappings.
Billing Code Overview
CPT code 92579 describes a comprehensive battery of behavioral and objective tests used to evaluate hearing in infants and toddlers. The procedure uses sound sources and measures auditory responses, with reinforcement by animated toys to encourage behavioral responses appropriate to the child’s developmental level.
-
Service type: Pediatric audiologic assessment using conditioned behavioral techniques
-
Typical site of service: Ambulatory audiology clinic or pediatric diagnostic center where pediatric hearing evaluations are performed
Clinical & Coding Specifications
Clinical Context
A 14-month-old toddler is brought to a pediatric audiology clinic by caregivers after delayed speech milestones and inconsistent responses to sounds at home. The child has no contraindications for testing and is alert and cooperative. The audiologist conducts a behavioral audiometry battery using age-appropriate sound sources (speech, warble tones) and employs conditioned play techniques reinforced by animated toys to elicit reliable behavioral responses. Testing is performed in a sound-treated booth with calibration-verified equipment. Findings guide decisions about further diagnostic testing (such as otoacoustic emissions or auditory brainstem response), amplification trials, early intervention referral, and medical evaluation for otitis media or sensorineural hearing loss. Typical encounter includes history review, otoscopic exam, test administration for each ear, documentation of thresholds or behavioral responses, caregiver counseling, and report generation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component separate from technical services. |
59 | Distinct procedural service |