CurrentUnitedHealthcarePolicy N/A

Otoacoustic Emissions (OAE) Testing Reimbursement

Governs UnitedHealthcare Community Plan Medicaid reimbursement for professional OAE testing services billed on CMS1500 (or electronic equivalent) and applies to network and non-network clinicians providing those services.

Policy Summary

PayerUnitedHealthcare

PolicyOtoacoustic Emissions (OAE) Testing Reimbursement

Policy CodePolicy N/A

Change TypeNo material change noted

Effective DateN/A

Next Review DateN/A

Key ActionDeny CPT codes 92558, 92587, and 92588 when not submitted with an allowed diagnosis for members age 4 years and older.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

MedicaidProduct applicability

90 daysNeonatal age limit

<4 yrsPediatric NEC upper age

3OAE CPT codes noted

2-stage universalRecommended screening protocol

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OAE testing coverage criteria

Medical necessity and noncovered conditions for OAE testing are defined by age and clinical circumstance.

ALL of the following

Neonatal hearing screening using OAEs is medically necessary for infants age 90 days or younger.

ANY of the following

OAE testing is medically necessary for evaluation of hearing loss in infants and children age 3 years (up to, but not including, their 4th birthday).
OAE testing is medically necessary for children and adults who are unable to cooperate with other methods of hearing testing (for example, individuals with autism or stroke).

ALL of the following

Auditory screening or diagnostic OAE testing is not medically necessary for other patient populations and conditions including ototoxic hearing changes in individuals treated with ototoxic medications, noise-induced hearing loss, sudden hearing loss, tinnitus, and other suspected hearing loss in older children or adults due to inadequate evidence of improved outcomes.

ALL of the following

CPT codes 92558, 92587, and 92588 will be denied when not submitted with an allowed diagnosis for members age 4 years and older.

Coverage considerations and implied criteria

Evidence-based considerations for when OAE screening is appropriate or promising:

ALL of the following

OAE screening demonstrates high sensitivity in specific populations (e.g., post-meningitis inpatients) and may be appropriate for inpatient screening following meningitis.

ALL of the following

OAE (TEOAE/DPOAE) may be used as a school-age screening tool, often in combination with tympanometry; test performance depends on chosen pass/fail criteria (e.g., SNR thresholds) and frequencies tested.

ALL of the following

OAE testing can be useful in special populations (intellectual disabilities, Down syndrome, autism) for detection or triage of hearing impairment; screening protocols should include repeat testing or diagnostic follow-up when screens fail.

ALL of the following

Coverage considerations and clinical criteria

Evidence-summary coverage considerations and clinical guidance drawn from studies and professional bodies:

ALL of the following

Screening of newborns/infants and monitoring high-risk infants (including NICU) should include tests that detect auditory neuropathy; OAE alone may be insufficient to detect neural auditory disorders.

ALL of the following

Use diagnostic ABR (often sedated) for definitive testing in infants and young children unable to complete behavioral audiometry; diagnostic ABR provides information accurate enough for therapeutic intervention.

ALL of the following

OAE testing can detect minor cochlear dysfunction after ototoxic exposure in some small studies and may be useful for monitoring, but evidence is inconsistent and larger trials are needed to demonstrate impact on outcomes.

ALL of the following

OAE use cases and limitations

Situations and patient groups where OAE testing is recommended or appropriate per cited guidance:

ALL of the following

Newborns: universal screening using OAE as part of a validated 1- or 2-step protocol (OAEs followed by ABR for those who fail) with quality control and timely diagnostic follow-up; screening before 1 month and diagnostic evaluation by 3 months are recommended.

ALL of the following

NICU: infants admitted more than 5 days should have ABR included in screening (automated ABR preferred) to detect auditory neuropathy; referral for re-screening or comprehensive evaluation is indicated for those who fail automated ABR.

ANY of the following

Use OAEs and/or ABR when behavioral audiometry is infeasible; ASHA suggests OAEs as an alternative through age 2 and includes protocols up to 60 months when behavioral tests are unreliable.

ALL of the following

CPT / Coding and Performance Metrics

OAE-related CPT codes subject to reimbursement criteriaCPT

92558	Otoacoustic emissions; limited (single stimulus)
92587	Distortion product evoked otoacoustic emissions; limited
92588	Distortion product evoked otoacoustic emissions; comprehensive

Form/administrative referencemixed

No codes listed

DPOAE performance metricsmixed

No codes listed

FDA device classifications referencedmixed

No codes listed

inv-09: Neonatal medical necessity age limit — value summary (age threshold)

Neonatal age threshold90 days or younger

Policy contextNeonatal hearing screening using OAEs is medically necessary for infants who are 90 days or younger

Denial rule linkageCPT codes 92558, 92587, 92588 denied without allowed diagnosis for members age 4 years and over (neonatal exceptions apply)

inv-10: Pediatric medical necessity age upper limit — children age 3 years (up to, but not including, 4th birthday)

Upper pediatric age limitChildren age 3 years (up to, but not including, 4th birthday)

Allowed use caseOAE testing medically necessary for evaluation of hearing loss in infants and children age 3 years or younger

RationalePolicy permits OAE screening up to age 4 to comply with newborn hearing screening guidance and testing research considerations

inv-11: Suggested OAE SNR/pass criteria considerations — studies report varying optimal SNR/pass thresholds; examples and caveats

Variable SNR recommendationsStudies report differing optimal SNR/pass thresholds; example: Driscoll et al found SNR criterion ≥1 dB provided best performance for TEOAE in schoolchildren

Frequency-specific considerationsDPOAE performance varies by frequency; Lyons et al found compromised performance at 1.1 kHz and advised against a fixed SNR across all frequencies

Protocol implicationsSelection of SNR cutoff and inclusion/exclusion of low-frequency data materially affects sensitivity/specificity and should guide pass/fail criteria

inv-12: DPOAE detectable hearing level threshold — identifiable hearing levels less than ~34-40 dB HL depending on frequency

Detectable hearing level range (example)Identifiable hearing levels less than ~34 dB HL (at 2.0 and 4.0 kHz) and ≤38–40 dB HL at some frequencies (study-specific Cochlea-Scan estimates)

Clinical implicationDPOAE protocols can detect mild hearing deficits (less than ~40 dB HL) but threshold estimates vary by device and algorithm

Study limitationsPerformance estimates derived from small samples and specific devices/algorithms; generalizability limited

inv-13: timing thresholds for follow-up — screening by 1 month, diagnostic eval by 3 months, intervention by 6 months (guideline-based)

Screening and follow-up timelineScreening by 1 month, diagnostic evaluation by 3 months, intervention by 6 months

Guideline sourcesJCIH recommends screening no later than 1 month, diagnostic audiology by 3 months, intervention by 6 months; USPSTF endorses validated 1- or 2-step protocols with OAEs followed by ABR

NICU noteSeparate NICU protocols recommended; infants admitted >5 days should have ABR included to detect neural hearing loss

Billing, Prior Authorization, and Follow-up Actions

Note

Confirmatory testing and special-population screening

UnitedHealthcare Community Plan requires confirmatory testing and special-population screening consistent with national guidance. Diagnostic ABR should be used when an infant or young child is uncooperative or when there is concern for neural auditory disorders, because OAE testing alone can miss auditory neuropathy/auditory dyssynchrony. Audiologic evaluation is indicated for any infant or child who demonstrates delayed auditory or communication development, even if they passed newborn hearing screening. For children who are uncooperative, diagnostic OAE or sedated ABR may be obtained.

Use diagnostic ABR for definitive testing in infants/children unable to cooperate or when neural auditory disorder suspected
Repeat audiometric testing in a sound booth and other tests per audiologist when screening fails
Include OAE testing in subsequent audiologic assessments for infants/children birth to 36 months, per JCIH

Prior Authorization

Follow-up and NICU screening recommendations

Follow-up and NICU screening recommendations: infants who demonstrate delayed auditory or communication development should receive prompt audiologic evaluation regardless of newborn screening results. Because auditory neuropathy/dyssynchrony is more common in infants who required NICU care, these infants should be screened using technology capable of detecting neural conduction disorders (automated ABR). A failed OAE requires confirmatory testing (repeat OAE and/or ABR) and expedited audiologic evaluation; diagnostic ABR (often performed under sedation or general anesthesia in infants around 3–6 months and older) provides information accurate enough to allow therapeutic intervention.

NICU infants: screen with automated ABR to detect auditory neuropathy/auditory dyssynchrony
Infants who fail initial OAE: ensure expedited confirmatory testing (repeat OAE and/or ABR) and audiologic evaluation before 3 months of age
Infants with language delays: refer for audiologic and comprehensive speech/language evaluation

Note

Newborn screening protocols

Newborn screening protocols should follow validated 1- or 2-step approaches that include OAEs and ABR as appropriate. Programs must have quality-control processes to reduce avoidable false positives and ensure infants with positive screening results receive timely audiologic evaluation and follow-up after discharge. Newborn hearing screening should occur before 1 month of age, with confirmatory audiologic and medical evaluation completed by 3 months for those who do not pass. Universal two-stage OAE followed by ABR prior to discharge (or within first 3 months if born elsewhere) is recommended.

Implement a validated 1- or 2-step protocol: OAE screening first, then ABR for infants who fail OAE
Ensure quality-control measures to minimize false positives
Ensure infants who fail screening receive audiologic and medical evaluation by 3 months of age
Perform universal screening prior to hospital discharge or within first 3 months for outborn infants

Definitions and Test Descriptions

inv-19: OAE — Low-intensity sounds emitted by functioning outer hair cells; includes TEOAE and DPOAE modalities; screening but limited diagnostic scope.

Basic definitionLow-intensity sounds emitted by functioning outer hair cells of the cochlea, measured via a probe in the ear canal

ModalitiesIncludes transient-evoked (TEOAE) and distortion-product (DPOAE) modalities

Clinical roleObjective, nonbehavioral screening tests useful for newborn and difficult-to-test populations but with limited diagnostic scope — do not assess neural transmission

inv-20: DPOAE/TEOAE testing — refers to transient evoked and distortion product measures of cochlear outer hair cell function used for hearing screening and evaluation.

DefinitionRefers to transient evoked (TEOAE) and distortion product (DPOAE) measures of cochlear outer hair cell function

Typical usesUsed for hearing screening in infants, schoolchildren, and as part of combined protocols (often with tympanometry) in screening programs

Performance variabilityTest performance depends on chosen pass/fail criteria and frequencies tested; combining with tympanometry can improve accuracy

inv-21: OAE — objective tests (TEOAE, DPOAE, etc.) that assess cochlear outer hair cell function but do not test neural transmission.

Objective test natureOAEs (TEOAE, DPOAE, etc.) are objective physiologic tests that assess cochlear outer hair cell function

Neural limitationsOAEs do not assess neural transmission and will miss auditory neuropathy or neural conduction disorders

Clinical implicationNormal OAE does not exclude neural auditory disorders; failed OAE requires further diagnostic evaluation (e.g., ABR)

inv-22: Automated ABR — objective test capable of detecting neural conduction disorders and recommended for NICU infants and specific indications.

DefinitionAutomated ABR is an objective test capable of detecting neural conduction disorders

Recommended populationsRecommended for NICU infants (especially those admitted >5 days) and other at-risk infants to detect auditory neuropathy

Role vs OAEAutomated ABR complements OAEs and is required in protocols where neural hearing loss is a concern; failed OAE should be followed by ABR for confirmation

inv-23: OAE — reiteration of OAEs: transient-evoked and distortion-product that assess cochlear outer hair cell function.

Restated definitionOAEs are low-intensity sounds generated by outer hair cells and measured with an ear-canal probe

TEOAE and DPOAETransient-evoked and distortion-product OAEs are the primary clinical modalities; TEOAEs often used for screening, DPOAEs for cochlear/damage assessment

Screening scopeUseful for newborn screening and for individuals unable to complete behavioral testing, but not a standalone diagnostic of neural function

inv-24: ABR — Auditory brainstem response: electrophysiologic test assessing neural transmission; recommended in NICU >5 days and other indications.

ABR definitionAuditory brainstem response (ABR) is an electrophysiologic test assessing neural transmission from the cochlea through the brainstem

Diagnostic roleDiagnostic ABR is often definitive in infants/young children unable to cooperate and provides information accurate enough to allow therapeutic intervention

NICU recommendationJCIH recommends including ABR in screening for NICU infants admitted >5 days to detect auditory neuropathy/dyssynchrony

OpenPayer

Otoacoustic Emissions (OAE) Testing Reimbursement

Coverage Criteria and Considerations

CPT / Coding and Performance Metrics

Billing, Prior Authorization, and Follow-up Actions

Definitions and Test Descriptions