Summary & Overview
CPT 92626: Auditory Functional Evaluation for Hearing Implant Candidacy
CPT code 92626 represents a clinician-performed auditory functional status evaluation lasting the first or only hour. The assessment evaluates sound perception, listening ability, orienting movements, and balance to determine candidacy for surgically implanted hearing devices or to assess the performance of an existing implant. Nationally, this code is important for care pathways linking diagnostic audiology to device-based interventions and for appropriate billing of specialized auditory evaluations.
This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical intent and typical sites of service for CPT code 92626, commonly associated billing modifiers (listed separately), and the payer scope addressed. The publication summarizes benchmarks related to use and payment patterns where available, highlights relevant policy or coverage considerations affecting implant candidacy assessments, and provides clinical context to inform coding accuracy and documentation needs.
The content is targeted to health policy analysts, coding professionals, and clinical managers seeking a concise summary of CPT code 92626’s role in the diagnostic and pre- or post-implantation workflow. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 92626 describes a comprehensive auditory functional status evaluation performed by a qualified provider. The service assesses sound perception, listening ability, orienting movements, and balance to determine candidacy for a surgically implanted hearing device or to evaluate the efficacy of an existing implanted device. This code represents the first or only hour of evaluation.
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Service type: Diagnostic auditory functional evaluation
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Typical site of service: Audiology clinic, otolaryngology (ENT) clinic, hospital outpatient department, or specialty hearing center
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Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with progressive sensorineural hearing loss is evaluated in a specialty audiology clinic to determine candidacy for a surgically implanted hearing device (e.g., cochlear implant or bone-anchored hearing system) and to assess performance of an existing implant. The clinical workflow begins with a referral from an otolaryngologist or primary care provider. The patient completes a focused history addressing onset, duration, asymmetric loss, speech understanding in noise, tinnitus, prior hearing aid use, and prior ear surgeries. The provider performs a comprehensive auditory functional status evaluation including pure-tone and speech perception testing in quiet and noise, objective aided and unaided tests as indicated, assessment of sound localization/orienting movements, and balance screening if vestibular symptoms are reported. For candidacy assessment, device trialing and counseling about expected outcomes occur; for post-implant assessment the provider documents device function, aided speech scores, and any need for device reprogramming or surgical revision. Testing typically occupies the first hour of face-to-face time represented by 92626. Typical site of service is an outpatient audiology or otolaryngology clinic, ambulatory surgical center for preoperative candidacy assessments, or a hospital outpatient department for complex cases.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |