Summary & Overview
CPT 92629: Hearing-Aid Candidacy Evaluation, Additional 15 Minutes
CPT code 92629 is an add-on, time-based code for additional 15-minute increments of provider time spent evaluating a patient’s candidacy for hearing aids. It documents extended clinical activity beyond the primary hearing-aid candidacy evaluation and is used in outpatient audiology and ENT settings where providers review test results, assess amplification needs, and counsel patients. Nationally, accurate use of 92629 matters for clinical documentation, care coordination for patients with hearing loss, and appropriate capture of provider time in reimbursement workflows. Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of what 92629 represents, how it fits into a hearing-aid candidacy service line, and the clinical context for its use. The publication summarizes common billing practices and benchmarking topics such as typical sites of service, utilization drivers, and documentation expectations. It also outlines where data is available and where input was not provided. Data not available in the input: detailed payer-specific coverage policies, common modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and service-line financial benchmarks.
Billing Code Overview
CPT code 92629 describes an add-on service in which the provider evaluates whether a patient is a candidate for hearing aids for one or both ears. The service includes review of test results, assessment of hearing needs, and counseling the patient. This code represents each additional 15 minutes of provider time beyond the primary candidacy evaluation service.
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Service type: Hearing-aid candidacy evaluation (add-on time-based service)
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Typical site of service: Audiology clinic, ENT clinic, or other outpatient settings where hearing evaluations and counseling are provided.
Clinical & Coding Specifications
Clinical Context
A 72-year-old retired teacher presents to an outpatient audiology clinic reporting progressive difficulty hearing conversation, especially in noisy environments, over the past 18 months. The patient completed pure-tone audiometry, speech audiometry, and tympanometry. The audiologist reviews test results, documents bilateral sensorineural hearing loss consistent with presbycusis, assesses the patient’s communication needs, prior amplification experience, dexterity, and cosmetic preferences, and provides counseling on amplification options. The clinician conducts real-ear measurements and discusses realistic outcomes, follow-up schedule, and device care. The initial evaluation and fitting session required 45 minutes; after the primary service time was accounted for, an additional 15-minute block of counseling and programming was billed using 92629 to represent each extra 15 minutes beyond the primary hearing-aid candidacy evaluation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional component of a service if the technical component was performed by another entity. |
59 |