What Does CPT Code 69210 Represent?

CPT 69210 is defined as the removal of impacted cerumen requiring instrumentation, unilateral. That means the procedure involves using a tool like a curette, suction device, or forceps to manually extract hardened or obstructive earwax from a patient’s external ear canal. The key here is instrumentation. If no instrument is used, this code doesn’t apply.

It’s important to note that 69210 is a unilateral code. If a provider removes impacted wax from both ears, they must indicate that accordingly—either by using laterality modifiers (RT and LT) or a bilateral modifier (50), depending on payer policy.

When Should You Use CPT 69210?

Not all earwax removals qualify for this code. CPT 69210 should only be used when the cerumen is truly impacted—not just present.

Impacted cerumen typically meets one or more of the following conditions:

• It prevents a full examination of the ear canal or tympanic membrane
• It causes symptoms like pain, hearing loss, itching, or dizziness
• It’s associated with infection or inflammation
• It requires physician-level skill and specialized tools for safe removal

If the earwax is soft, superficial, or can be removed easily with irrigation, CPT 69210 is not the correct code. In those cases, CPT 69209—which covers removal using irrigation or lavage—should be used instead.

69210 vs 69209: Knowing the Difference

A common ENT billing mistake is confusing these two codes. While both refer to earwax removal, the methods involved are very different.

CPT 69210 is reserved for cases involving manual instrumentation. This is typically used when wax is dry, hard, or stuck deep in the canal and cannot be removed through flushing.

CPT 69209, introduced later, refers to removal via irrigation or lavage. This code reflects a lower complexity and reimbursement rate because it doesn’t involve the same level of clinical skill or risk.

Using the wrong code not only risks denial but could also raise red flags during audits.

Key Billing Rules to Get Right

Accuracy in billing 69210 goes beyond just choosing the right code. The supporting documentation is what secures reimbursement.

The provider’s notes must clearly indicate:

• That the cerumen was impacted
• The specific instrument used during removal
• Which ear was treated
• The medical necessity of the procedure
• That the work required physician-level expertise
  
  

Without these details, claims are likely to be flagged or denied—even if the service was performed correctly.

Also, remember that CPT 69210 does not include the use of a microscope. If binocular microscopy is used to assist the removal and the payer allows it, CPT 92504 may be billed separately.

The Role of Modifiers in CPT 69210

Modifiers are often where clean claims go wrong. When submitting CPT 69210, the following are the most relevant:

• RT (right ear) or LT (left ear): When the procedure is done on one side only
• 50 (bilateral procedure): If both ears are treated—but check with the payer, as Medicare does not accept modifier 50 for this code
• 25: If an E/M visit is billed on the same day and it was separate and medically necessary
• 59 or X-modifiers: If 69210 is performed alongside another unrelated procedure on the same date
• GA: If a service is expected to be denied due to coverage limitations and an ABN has been issued
  
  

Applying the wrong modifier—or skipping them entirely—is a top cause of denials for this code.

Can CPT 69210 Be Billed with an Office Visit?

Yes—but only under specific circumstances. If a provider performs an evaluation and management (E/M) service that is separate and distinct from the cerumen removal, both can be billed. This might happen, for example, if a patient visits for ear pain and a general exam is conducted before the decision is made to remove impacted wax.

In such cases, CPT 69210 would be billed alongside an E/M code like 99213, with modifier 25 applied to the E/M code.

Just make sure the notes reflect that:

• The cerumen was impacted
  
  
• The evaluation was separate
• The provider’s skill was required
• All necessary components of the E/M visit were fulfilled
  
  

Scenarios That Clarify Correct Use

Let’s explore a few real-world examples to bring it all together:

Scenario 1: Pediatric Case
An 8-year-old is brought in with ear pain and muffled hearing. The ENT discovers hard, dark wax obstructing the left ear and removes it using forceps.
Correct Code: 69210 with LT

Scenario 2: Eczema Complication
A 15-year-old with eczema experiences itching and fullness in one ear. The provider uses a curette to remove dry, flaky wax from the right side.
Correct Code: 69210 with RT

Scenario 3: Adult Referred for Hearing Test
A 67-year-old referred for audiology testing has impacted wax in both ears. The ENT uses suction and curettes to remove it from both sides.
Correct Code: Either 69210 billed twice with RT and LT, or once with modifier 50, depending on payer policy.

Can Audiologists Use This Code?

Under Medicare rules, audiologists cannot bill CPT 69210. If cerumen removal is required on the same day as audiology testing, a physician must perform and bill for the service.

For those scenarios, the HCPCS code G0268 may be used, particularly if performed to enable audiology testing. Be aware that G0268 is inherently bilateral, so only one unit should be billed, even if both ears are treated.

Avoiding Common Claim Denials

The most common reasons 69210 claims get denied include:

• Billing the code when only irrigation was performed
• Missing or incorrect modifier use
• Lack of documentation showing impaction
• Audiologist billed the code under Medicare
• Bilateral billing without payer-specific approval
• No evidence of provider-level instrumentation
  
  

A thorough note that clearly states impaction, instrumentation, and medical necessity will go a long way in preventing rejections.

In Summary

CPT 69210 might seem straightforward, but its billing requires precision. Using the right code is only part of the process—the details in documentation, modifier selection, and payer-specific rules are what truly determine whether a claim is approved.

By understanding the clinical definition of impaction, knowing when irrigation disqualifies this code, and accurately describing the removal method, healthcare professionals can reduce denials and ensure proper reimbursement.

If you’re billing this code regularly, reviewing your team’s documentation habits and modifier usage can have a direct impact on your revenue cycle. Clean documentation and accurate coding are the best defense against claim denials.