Summary & Overview
CPT 92631: Hearing Aid Selection and Counseling, First 30 Minutes
CPT code 92631 represents the first 30 minutes of hearing aid selection and counseling for one or both ears, including review of hearing test results, evaluation of patient abilities and lifestyle, and recommendations on device features. Nationally, this code matters because it captures clinician time and counseling that influence device choice, patient outcomes, and downstream durable medical equipment utilization. Coverage and payment policies for hearing aid selection affect access to appropriate amplification and can vary across commercial payers and Medicare.
This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an explanation of the clinical service represented by the code, typical sites of service, and which stakeholders commonly bill for the service. The publication also summarizes available benchmarks and policy context relevant to billing and coverage for hearing aid selection, noting variations in payer approaches and potential implications for providers and patients. Where data is not provided in the input, the report indicates that information is not available.
Billing Code Overview
CPT code 92631 describes the selection of hearing aids for one or both ears. The service includes review of prior hearing test results, consideration of the patient’s abilities and lifestyle, and recommendation of appropriate device features. This code represents the first 30 minutes of the selection process.
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Service type: Hearing aid selection and consultation
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Typical site of service: Audiology clinic, otolaryngology clinic, or other outpatient settings where hearing aid selection and counseling are provided
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with progressive bilateral sensorineural hearing loss presents for hearing aid selection. The audiologist or otolaryngologist reviews recent pure-tone and speech audiometry, tympanometry, and speech discrimination scores; assesses manual dexterity, cognitive status, and daily listening environments; discusses amplification goals and lifestyle needs; and demonstrates potential device features and styles. During the initial 30-minute selection visit, the provider compares instruments, considers ear-specific audiometric thresholds and physical fit, and documents recommendations for one or both ears using 92631 to represent the first 30 minutes of hearing aid selection and counseling.
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 | Use when a distinct E/M visit is performed the same day as 92631 and is documented separately. |
26 | Professional component | Use when billing only the professional component of a service when technical component is billed separately.
59 | Distinct procedural service | Use when 92631 is a distinct, separate service from other procedures provided on the same day (use with caution and documentation).
76 | Repeat procedure or service by same provider | Use when the hearing aid selection service is repeated later the same day by the same provider.
77 | Repeat procedure or service by another provider | Use when another qualified provider repeats the selection service the same day.
91 | Repeat clinical diagnostic laboratory test | Not typically used for 92631; included for completeness when repeated objective tests drive selection decisions.
LT | Left side | Use when the service applies specifically to the left ear.
RT | Right side | Use when the service applies specifically to the right ear.
SC | Serious condition or birth-related services | Rarely used; apply only if mandated by payer for special circumstances.
GA | Waiver of liability statement on file (patient refuses/not applicable) | Use when required by payer policy regarding advance beneficiary notice or device waiver.
| Taxonomy Code | Specialty | Notes |
|---|---|---|
208D00000X | Otolaryngology (ENT) | Physicians who evaluate hearing and prescribe hearing aids. |
261QM1100X | Audiology | Audiologists who perform hearing evaluations and hearing aid selection.
363A00000X | Hearing Instrument Specialist | Licensed providers who perform hearing aid selection and fittings.
207K00000X | Family Medicine | Primary care clinicians who may initiate referral and participate in counseling about amplification.
207L00000X | Internal Medicine | Internal medicine providers involved in care coordination for older adults with hearing loss.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
H90.3 | Sensorineural hearing loss, bilateral | Common indication for hearing aid selection and fitting documented during 92631. |
H90.41 | Sudden idiopathic hearing loss, right ear | May prompt urgent evaluation; hearing aid selection may follow if residual loss persists.
H91.90 | Unspecified hearing loss, unspecified ear | Used when testing confirms clinically significant hearing loss requiring amplification.
H91.92 | Mixed conductive and sensorineural hearing loss, unspecified ear | Influences device selection (e.g., power or earmold considerations) documented during selection.
R42 | Dizziness and giddiness | Vestibular symptoms often co-occur with auditory complaints and may be noted during assessment for amplification.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
92557 | Comprehensive audiometry threshold evaluation and speech recognition — includes pure-tone air and bone, speech recognition | Often performed prior to 92631 to provide audiometric data that inform hearing aid selection. |
92567 | Tympanometry, including reflex threshold measurements when performed | Used in the diagnostic workup before hearing aid selection to rule out middle ear pathology.
92630 | Evaluation of speech sound perception with cochlear implant, with or without programming | Separate rehabilitation/evaluation pathway; listed as related for clarity when cochlear implant candidacy is considered rather than hearing aids.
92633 | Tracing and programming of cochlear implant sound processor | Relevant when implantable devices are an alternative to amplification; not performed during standard hearing aid selection.
97799 | Unlisted physical medicine/rehabilitation service or procedure | Occasionally used by some providers for non-standard hearing device services not described by other codes; use per payer guidance.