CurrentEmblemHealthPolicy MG.MM.ME.33bC3

Otoacoustic Emissions Testing Medical Policy Emblemhealth

Defines medical necessity, covered indications, and non-covered/experimental uses of otoacoustic emissions (OAE) testing (CPT 92558, 92587, 92588) including screening and diagnostic contexts across neonatal, pediatric, and other patient populations; includes extensive applicable ICD-10 diagnosis code list and guideline references.

Policy Summary

PayerEmblemHealth

PolicyOtoacoustic Emissions Testing Medical Policy Emblemhealth

Policy CodePolicy MG.MM.ME.33bC3

Change TypeRevisions & historical edits

Effective Date

Next Review Date

Key ActionTreating physician or primary care provider must submit clinical evidence that the member meets the criteria for the requested test for preauthorization or post-payment review; EmblemHealth will not review without documentation.

SourceLink

POLICY UPDATE CHANGES

Apr. 14, 2023: Individuals with 'abnormal auditory perception' changed to 'auditory neuropathy spectrum disorder (ANSD) or auditory processing disorder (APD)'.

Apr. 12, 2019: Title changed to Otoacoustic Emissions Testing; diagnostic indications added; routine evoked OAE screening at well-child visits qualified; comprehensive auditory evoked response testing and comprehensive otoacoustic emissions designated experimental/investigational.

Nov. 1, 2011: Inception date.

3Covered CPT codes

>=100Applicable ICD-10 codes listed

2Procedure categories

Coverage Summary

Overview: This policy addresses Otoacoustic Emissions (OAE) Testing and defines when screening and diagnostic OAE procedures (CPT 92558, 92587, 92588) are considered medically necessary. The coverage stance is mixed, with specified covered indications for neonatal and pediatric screening and for diagnostic use in selected populations, and explicit limitations/non-covered uses (including routine well-child OAE screening and use of comprehensive OAE for initial screening). The policy covers 3 CPT codes across 2 procedure categories (screening vs diagnostic).

Key quick facts

Policy numberMG.MM.ME.33bC3

StatusCURRENT

Last review2026-04-10

Notable procedure categoriesscreening vs diagnostic = 2

Covered CPT codes (count)3

Medical Necessity Criteria

Covered Indications for CPT code 92558 (screening)

Covered when ALL of the following are met:

ALL of the following

Neonatal and early childhood screening: Neonatal hearing screening as a preventive service using otoacoustic emissions (OAEs) is proven and/or medically necessary for infants who are 90 days or younger
Screening for young children without prior neonatal screen or who cannot be tested by audiometry: Evoked OAE is considered medically necessary to screen children 3 years of age and younger who did not have the initial neonatal screening and/or cannot be effectively measured or monitored through audiometry

Covered Indications for CPT codes 92587 and 92588 (diagnostic evaluations)

Covered when ANY of the following indications are present:

ANY of the following

Applicable Codes

Covered / Applicable Procedure CodesCPTCovered

92558	Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated
92587	Distortion product evoked otoacoustic emissions, screening
92588	Comprehensive otoacoustic emissions, limited or diagnostic

Non-covered / Experimental Procedure CodesCPTNot Covered

92588

Comprehensive otoacoustic emissions — considered experimental/investigational for initial screening

Applicable ICD-10 Diagnosis Codes (covered reasons/indications)ICD-10

G04.2	Encephalitis and encephalomyelitis in bacterial diseases classified elsewhere
G20	Parkinson disease
G21.0	Secondary parkinsonism due to encephalitis
G21.3	Secondary parkinsonism due to drugs and metabolic disorders
G21.4	Vascular parkinsonism
G21.8	Other secondary parkinsonism
G21.9	Secondary parkinsonism, unspecified
G21.11	Postinfectious parkinsonism
G23.0	Progressive supranuclear ophthalmoplegia
G23.1	Striatonigral degeneration

1–10 of 118

1/12

Provider Actions

Documentation Required

Submit clinical evidence for medical necessity

Treating physician or primary care provider must submit clinical evidence that the member meets the criteria for the requested test for preauthorization or post-payment review; EmblemHealth will not review without documentation.

92558
92587
92588

Background and Guideline References

Background: OAE testing evaluates cochlear (outer hair cell) function by measuring otoacoustic emissions generated in response to stimuli: TEOAE from wide-band clicks and DPOAE from tones; stimuli are delivered via an ear-canal probe and responses are recorded and averaged.

Common uses: OAEs are used for newborn hearing screening, for screening young children or patients who cannot reliably complete behavioral audiometry (infants, developmental or cognitive impairment, uncooperative patients), for evaluation of tinnitus or suspected malingering, and for monitoring cochlear (ototoxic) injury during and after exposure to agents such as aminoglycosides or chemotherapy.

Limitations: OAEs assess cochlear hair-cell function but do not evaluate neural transmission. As noted by the AAP and the guideline, OAEs may miss auditory neuropathy and other neural abnormalities; in such cases or when definitive evaluation is required, Auditory Brainstem Response (ABR) (diagnostic ABR, often performed under sedation in infants) may be required for confirmation.

Definitions

Applicable Diagnosis Criteria

Revision History

Nov. 1, 2011added

Inception date.

Apr. 12, 2019revised

Title changed to Otoacoustic Emissions Testing; diagnostic indications added; routine evoked OAE screening at well-child visits qualified; comprehensive auditory evoked response testing and comprehensive otoacoustic emissions designated experimental/investigational. Content changes effective Jul. 15, 2019.

Apr. 14, 2023revisedLatest

Individuals with 'abnormal auditory perception' changed to 'auditory neuropathy spectrum disorder (ANSD) or auditory processing disorder (APD)'.