Summary & Overview
HCPCS G0268: Removal of Impacted Cerumen With Audiologic Testing
HCPCS Level II code G0268 denotes physician-performed removal of impacted cerumen (one or both ears) when done on the same date as audiologic function testing. The code clarifies billing for combined services where cerumen impaction is addressed to permit or accompany diagnostic audiology procedures. Nationally, accurate use of this code affects claims processing and appropriate payment for concurrent diagnostic and minor procedural services.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, typical clinical settings and service types, and an outline of common modifiers and payer considerations where available. The publication provides benchmarks and policy context relevant to billing for combined cerumen removal and audiologic testing, plus guidance on documentation expectations and coding interactions.
This summary equips clinicians, billing professionals, and policy analysts with an understanding of when HCPCS Level II code G0268 applies, which payers commonly recognize it, and what to expect in claims adjudication and review processes. Data not available in the input is noted where specific payer policies or utilization benchmarks are required.
Billing Code Overview
HCPCS Level II code G0268 describes removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing. This service covers manual or instrument-based extraction of earwax that is obstructing the ear canal when performed on the same date as audiologic testing.
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Service type: Cerumen removal performed by a physician in conjunction with audiologic function testing
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Typical site of service: Audiology clinic, physician office, or outpatient setting where audiologic function testing is performed
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient presents to an outpatient audiology clinic with progressive hearing difficulty and aural fullness prior to scheduled audiologic function testing. Examination by the treating physician identifies impacted cerumen obstructing the external auditory canal(s). On the same date as diagnostic audiometry, the physician performs manual removal of impacted cerumen from one or both ears to permit accurate testing. Typical workflow: the patient checks in to the ambulatory clinic or hospital-based outpatient department; the audiologist coordinates testing but documents inability to complete testing until cerumen is removed; the physician evaluates the ear, performs otoscopic exam, documents indication and technique (manual removal with curette, suction, or irrigation as appropriate), documents laterality and any complications, and then the audiologic testing (pure tone, speech audiometry, tympanometry as indicated) is completed the same day. Typical site of service: outpatient hospital-based clinic, ambulatory surgical center, or physician office co-located with audiology. Common clinical reasons: cerumen obstructing visualization of the tympanic membrane and preventing accurate audiologic assessment, symptomatic cerumen causing hearing loss, or pre-procedure clearance for hearing aid fitting or ENT evaluation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day | Use when a distinct E/M visit is provided in addition to the procedure on the same day. |