Summary & Overview
CPT 92628: Hearing Aid Candidacy Evaluation, First 30 Minutes
CPT code 92628 represents a clinician’s evaluation to determine hearing aid candidacy for one or both ears, covering the first 30 minutes of the consultative assessment. The code matters nationally because it captures a common, clinically important audiology service tied to diagnosis, counseling, and device planning for patients with hearing impairment. Proper use affects clinical workflow, documentation, and reimbursement for outpatient audiology and ENT practices.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the service captured by the code, typical sites of service, and the clinical context for use. The publication summarizes billing benchmarks and payment considerations where available, highlights relevant coding relationships, and outlines documentation elements that commonly support billing for the initial 30-minute evaluation. Information about payer-specific coverage policies and reimbursement benchmarks is presented to help clinical and billing staff understand variation across major national payers.
Data not available in the input for payers’ specific modifiers, associated taxonomies, ICD-10 diagnoses, and related codes are noted where applicable.
Billing Code Overview
CPT code 92628 describes the provider's evaluation to determine whether a patient is a candidate for hearing aids in one or both ears. The service includes review of prior and current audiometric test results, assessment of the patient’s hearing needs and lifestyle, and counseling about hearing aid options and expected outcomes. This code represents the first 30 minutes of the hearing aid candidacy evaluation.
Service Type: Hearing aid candidacy evaluation, diagnostic/consultative audiology service.
Typical Site of Service: Audiology clinic, otolaryngology (ENT) office, or outpatient hearing center.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult experiencing hearing difficulty, trouble understanding conversations in noisy environments, or who reports progressive sensorineural hearing loss. The patient is referred to an audiology or otology clinic after a primary care visit or self-referral. At the visit, the provider (audiologist or otolaryngologist) reviews prior audiometric test results or performs updated pure-tone and speech audiometry, tympanometry, and speech-in-noise testing as needed. The clinician assesses ear health, discusses amplification goals, evaluates candidacy for amplification in one or both ears, and provides counseling on hearing aid types, benefits, limitations, realistic expectations, and use‑and‑care considerations. The documented service includes a focused review of diagnostic data, determination of whether hearing aids are appropriate, recommendations for device features, and counseling; 92628 represents the first 30 minutes of this evaluation. Typical site of service is an outpatient audiology clinic, otolaryngology office, or hearing center. The workflow may include scheduling device fitting and verification visits if the patient elects amplification, obtaining prior authorization if required by payer, and coordinating with dispensing services or vendors for procurement and follow-up aural rehabilitation as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure |