CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Audiology diagnostic and hearing tests — Coverage Criteria

This policy governs coverage and medical necessity of audiology evaluation and diagnostic hearing tests for Medicare Advantage and Commercial products from Blue Cross Blue Shield - Rhode Island, and describes which tests are covered, not covered, or considered obsolete.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyAudiology diagnostic and hearing tests — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionVerify member-specific benefits and order audiology studies from a physician or advanced practice provider; prior authorization is not required.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~40procedure and hearing-related codes mentioned

3recent provider updates (2019-2021)

Multipletests declared obsolete or not medically necessary

Coverage and Medical Necessity Criteria

Medically necessary indications

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Medically necessary indications: Evaluation of impairment tests are considered medically necessary in illnesses or injuries including, but not limited to: hearing loss; otitis media; Meniere's disease; labyrinthitis; vertigo (dizziness); tinnitus; cochlear otosclerosis; neoplasms of the auditory or central nervous system; congenital anomalies; surgery involving the auditory and/or central nervous system (e.g., skull-based tumors such as acoustic neuroma and meningioma); facial nerve paralysis (Bell's palsy); bacterial meningitis; exposure to intense noise; ototoxic drugs; fractures of the temporal bone or trauma affecting the central auditory pathways.

See policy statement for full list (chunk 3).

Tests by age group and specialized testing

Age-specific standard and specialized tests

Adult/Child standard tests: Standard tests for adults and children include pure-tone audiometry (air and bone conduction), speech audiometry, word recognition/word recognition (3-word) tests, tympanometry (impedance testing), and acoustic reflex testing including acoustic reflex decay.

See chunk 7 for list.

Children-only tests: Children-specific tests include conditioned play (conditioning play) audiometry and select picture audiometry.

See chunk 8.

Infant tests: Infant-specific tests include visual reinforcement audiometry (VRA), auditory evoked potential/Auditory Brainstem Response (ABR), evoked otoacoustic emissions (OAE), and acoustic reflex testing.

See chunk 9.

Specialized tests for adults and children that may be medically necessary when initial diagnostics are inconclusive or inappropriate include electrocochleography (ECochG), auditory evoked potentials (including neurodiagnostic and threshold estimation ABR testing), tone decay testing, sensorineural acuity level (SAL) testing, Stenger test (pure tone or speech), and evoked otoacoustic emissions.

See chunk 10 for specialized test list and indications.

The policy designates a subset of historical audiometric procedures as obsolete. These tests are not covered for Medicare Advantage plans and are considered not medically necessary for Commercial products. Coverage determinations apply to specific named procedures; providers should use currently accepted standard and specialized audiometric tests when evaluating hearing impairment or related conditions.

The policy explicitly lists the following tests as obsolete or not medically necessary:

1. Bekesy audiometry (screening and diagnostic) — listed as not covered / not medically necessary.

2. Short increment sensitivity index (SISI) — identified as obsolete and replaced by pure tone audiometry or auditory evoked potential.

3. Alternate binaural loudness balance test (loudness balance / loudness tests) — considered obsolete and not covered.

4. Lombard test — noted as replaced by the Stenger test and auditory evoked potential and considered obsolete.

5. Synthetic sentence identification test — designated not covered / not medically necessary due to lack of supporting evidence.

6. Staggered spondaic word test — designated not covered / not medically necessary due to lack of supporting evidence.

7. Audiometric testing of groups (92559) — listed among codes not covered for Medicare Advantage and considered not medically necessary for Commercial products.

CPT / HCPCS Coding

Covered CPT/HCPCS Codes (Medicare Advantage and Commercial where indicated)mixedCovered

92551	Screening test, pure tone, air only
92552	Pure tone audiometry (threshold); air only
92557	Comprehensive audiometry threshold evaluation and speech recognition
92550	Tympanometry and reflex threshold measurements
92553	Pure tone audiometry (threshold); air and bone
92555	Speech audiometry threshold
92556	Speech audiometry threshold; with speech recognition
92563	Tone decay test
92565	Stenger test, pure tone
92567	Tympanometry (impedance testing)

1–10 of 27

1/3

Not covered / Not medically necessary / Obsolete testsCPTNot Covered

92559	Audiometric testing of groups
92560	Bekesy audiometry; screening
92561	Bekesy audiometry; diagnostic
92562	Loudness balance test; alternate binaural or monaural
92564	Short increment sensitivity index (SISI)
92572	Staggered spondaic word test
92576	Synthetic sentence identification test

Provider Responsibilities and Billing Guidance

Prior Authorization

Prior authorization is not applicable for the hearing services and diagnostic hearing tests described in this policy.

Note

Benefit Verification

Benefits may vary by group/contract. Verify member-specific benefit documents (Benefit Booklet, Evidence of Coverage, or Subscriber Agreement) to determine coverage, applicable limitations, and member cost share before providing services.

Check the member's Benefit Booklet or Evidence of Coverage for hearing service benefits and limitations.
Confirm whether services are covered under the member's plan and any applicable frequency or age limits.

Billing Rule

Ordering and Benefit Verification

Audiology studies performed by independently licensed audiologists are covered when ordered by an authorized provider (physician or Advanced Practice Provider). Ensure the ordering provider is documented on the claim.

Covered when ordered by a physician or an Advance Practice Provider.
Document the ordering provider on the claim to support coverage.

Denial Risk

Denial Triggers — Not Covered Codes

Claims for the following audiometry and related codes are not covered for Medicare Advantage Plans and are considered not medically necessary for Commercial products; submitting these codes may result in claim denial.

92559 - Audiometric testing of groups
92560 - Bekesy audiometry; screening
92561 - Bekesy audiometry; diagnostic
92562 - Loudness balance test; alternate binaural or monaural
92564 - Short increment sensitivity index (SISI)
92572 - Staggered spondaic word test
92576 - Synthetic sentence identification test

Clinical Background

Hearing impairment ranges from slight reductions in sound perception to complete deafness and can be due to sensorineural (inner ear or neural pathway) or conductive (outer or middle ear) causes. Audiology is the clinical specialty focused on the identification, evaluation, and rehabilitation of hearing loss; licensed audiologists perform diagnostic and audiometric testing to characterize the type, degree, and functional impact of hearing impairment.

Standard audiometric assessments vary by age and clinical situation and typically include pure-tone audiometry (air and bone), speech audiometry and word recognition testing, tympanometry, and acoustic reflex testing. Specialized tests (for adults, children or infants) — such as auditory evoked potentials, electrocochleography, otoacoustic emissions, tone decay, and Stenger testing — are used when initial diagnostics are inconclusive, when objective measures are required, or when testing the very young or uncooperative patients.

Definitions and Test Descriptions

Audiology — definition and providers

Specialty definitionAudiology: a specialty focusing on identification, evaluation, and rehabilitation of hearing impairment or hearing loss, addressing sensorineural and/or conductive deficits.

Typical providersLicensed audiologists who perform audiometric and diagnostic tests to evaluate hearing and related disorders.

Scope of servicesEvaluation and diagnostic testing for hearing impairment across the lifespan (adults, children, infants), including initial work-up and follow-up specialized testing when indicated.

When specialized testing is usedSpecialized tests are used when initial diagnostic tests are inconclusive or not appropriate to the condition.

Standard and specialized audiometric tests by age group

Adults and children — standard batteryPure-tone audiometry (air and bone), speech audiometry including word recognition tests, tympanometry (impedance testing), and acoustic reflex testing/decay.

Children-only testsConditioned play audiometry and select picture audiometry for developmentally appropriate assessment.

Infant testsVisual reinforcement audiometry (VRA), auditory evoked potential / auditory brainstem response (ABR), evoked otoacoustic emissions (OAE), and acoustic reflex testing.

Specialized tests (when indicated)Electrocochleography, auditory evoked potentials, tone decay tests, Stenger and Stenger speech tests, sensorineural acuity level tests, and evoked otoacoustic emissions for cases where initial diagnostics are inconclusive or inappropriate.