CurrentUnitedHealthcarePolicy N/A

Audiologic/Vestibular Function Testing Reimbursement

Defines UnitedHealthcare Community Plan Medicaid reimbursement criteria for audiologic and vestibular function testing billed on CMS1500/UB04 forms for physicians and qualified health care professionals.

Policy Summary

PayerUnitedHealthcare

PolicyAudiologic/Vestibular Function Testing Reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionReport an appropriate ICD-10 diagnosis code at the claim line level that denotes a problem associated with balance or hearing to be reimbursed for audiologic/vestibular testing.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

one-pagedocument overview length

multipleexample procedure codes referenced

ID, IN, KS, MNstate-specific exceptions

claim-line requiredICD-10 requirement

ICD10 list 3/8/2026attachment update

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Reimbursement Criteria

Reimbursement criteria for audiologic/vestibular testing

UnitedHealthcare Community Plan will reimburse listed audiologic/vestibular CPT codes when an appropriate ICD-10 diagnosis code indicating a balance or hearing problem is present on the claim line. Claims without an appropriate ICD-10 diagnosis on the claim line will not be reimbursed.

CPT codes listed in the policy are reimbursable only when accompanied by an ICD-10 diagnosis code denoting a problem associated with balance or hearing on the claim line.

ICD-10 diagnosis codes must be reported at the claim line level for each CPT/HCPCS code to be considered for reimbursement.

Providers are responsible for submission of accurate claims using CPT/CMS coding guidelines on CMS-1500 or electronic equivalent; UnitedHealthcare may exercise discretion in application.

State exceptions (do not apply in all states)

Idaho: CPT codes 92517, 92518, 92519, and 92549 are non-covered per state regulations.
Indiana: CPT codes 92517, 92518, and 92519 are non-covered services for INHCC and INMLTSS per state regulations.
Kansas: Kansas is exempt from this policy based on state requirements.
Minnesota: CPT code 92548 is a non-covered service per state regulations.

Omitted/not included codes: CPT 92552, 92650, 92651 are not included due to screening use in pediatrics; CPT 92587 and 92588 are not included.

CPT and ICD-10 Coding Requirements

Covered audiologic/vestibular CPT codes when linked to appropriate ICD-10CPTCovered

92546	Audiologic/Vestibular function testing (example code listed)
92563	Audiologic/Vestibular function testing (example code listed)
92579	Audiologic/Vestibular function testing (example code listed)
92583	Audiologic/Vestibular function testing (example code listed)

ICD-10 reporting level

Reporting levelICD-10 diagnosis codes must be reported at the claim line level for each CPT/HCPCS procedure code to be considered for reimbursement.

PurposeLinks diagnosis to the specific service billed so UnitedHealthcare can determine medical necessity for audiologic/vestibular testing.

Supported byCoding edits and methodology derived from CMS Local Coverage Determinations and specialty society input.

Provider Billing and Submission Requirements

Prior Authorization

Diagnosis must be linked to each claim line

Report an appropriate ICD-10 diagnosis code at the claim line level that denotes a problem associated with balance or hearing; UnitedHealthcare Community Plan will not reimburse audiologic/vestibular testing when an ICD-10 diagnosis code that accurately reflects the member’s condition is not included on the claim.

Documentation Required

Submit accurate, guideline-compliant claims

Submit accurate claims using CPT/CMS coding guidelines on the CMS-1500 form or its electronic equivalent; UnitedHealthcare Community Plan may exercise reasonable discretion in interpreting and applying this policy and processing claims.

Use CMS1500 or electronic equivalent as required by the policy.
Follow CPT, CMS and other coding guidelines referenced by UnitedHealthcare Community Plan.

Definitions and Notes

ICD-10 diagnosis code — linkage requirement

Linkage requirementAn appropriate ICD-10 diagnosis code denoting a problem associated with balance or hearing must be listed on the claim line accompanying the CPT code for reimbursement.

Consequence of missing linkageUnitedHealthcare Community Plan will not reimburse when the claim does not include an ICD-10 diagnosis code accurately reflecting the member's condition.

DerivationThe procedure-to-diagnosis list was derived from convergence across CMS Local Coverage Determinations and specialty society information.

Attachment referenceSee the ICD-10 list in the Attachments section for diagnosis codes that should be linked with the CPT codes in the Reimbursement Guidelines.

CPT reference note

Reference purpose