CPT 92502 Explained: A Brief Guide on When to Apply It

How Audiologist decide whether 92502 is the correct code for this visit

Audiologists determine if 92502 is correct by confirming that both pure tone air and bone conduction threshold testing are performed for diagnostic purposes, not just screening. They also determine the use of code based on these points for their patients.

• If the clinician performs pure tone air and bone threshold testing with threshold determination (not just screening), 92502 is usually appropriate.
• If only pure-tone air conduction (screening) is done, they use a screening code (not 92502).
• If tympanometry, OAE, or diagnostic speech-language pathology procedures are performed, those may require separate CPTs — check bundling rules.

How Can Audiologist document properly for CPT 92502 (documentation checklist)

Experienced audiologist in the USA knows that good documentation supports reimbursement and reduces denials. At a minimum, include:

1. Reason for test, the symptoms, referral reason, screening vs diagnostic indication.
2. Patient baseline including age, relevant history (noise exposure, ototoxic meds, ear infections).
3. Test performed for pure tone audiometry — air conduction thresholds at frequencies, bone conduction thresholds at frequencies, and speech recognition performed using word list.
4. Equipment, the manufacturer/model and calibration status (date of last calibration).
5. Results, thresholds in dB HL by ear/frequency; PTA (pure tone average) if calculated; speech recognition score (%) and presentation level (dB HL or dB SL).
6. Interpretation: degree/type of hearing loss (e.g., mild sensorineural left ear).
7. Plan: next steps (retest, ENT referral, hearing aid evaluation) and who reviewed results.

How to code when tests are partial, repeated, or limited

Audiologist in the USA need to carefully code when test are repeated partially, they need to:

Partial testing (e.g., only air conduction) may not justify 92502, audiologist need to consider appropriate partial or screening codes (check each payer).

If repeat testing same day, the need to document medical necessity (e.g., patient non-response or equipment failure). Some payers may not pay for repeats without justification.

Unilateral vs bilateral, CPT 92502 is a single procedure that inherently describes bilateral testing when both ears are tested; billing is typically per patient encounter, not per ear. (Confirm with payer rules — some historical payers had different expectations.)

How CPT 92502 relates to other common audiology codes (quick reference table)

How to link ICD-10 diagnosis codes to CPT 92502 (common ICD-10s used)

• As an experienced healthcare professional you need to use primary diagnosis that justifies diagnostic testing (examples include choose the most specific that fits the patient):
• 3 Sensorineural hearing loss, bilateral
• 41 Unilateral conductive hearing loss, right ear
• 90 Unspecified hearing loss, unspecified ear
• 23 Sudden sensorineural hearing loss, bilateral
• 110 Encounter for hearing examination following failed hearing screening

How to bill modifiers and when to use them

Audiologists in the USA need to use billing modifiers correctly is important to avoid claim rejections and ensuring full reimbursement. Modifiers like -52 (reduced services) or -59 (distinct procedural service) should only be used when documentation clearly supports their necessity. Always follow payer-specific guidelines and include precise clinical notes to justify modifier usage. Modifiers sometimes used with audiology services:

1. Modifier -52 (reduced services), if a limited test was performed (document reason).
2. Modifier -59 / -X{E,P,S,U}, only when distinct procedural service rules apply and payer allows. Use cautiously.
3. Place of Service (POS), code appropriately office, hospital, outpatient clinic, SNF — as this affects payment.

How to handle payers with separate audiology provider types

Audiologists (AuD) and physicians have different scopes for billing: audiologists often bill using CPTs for diagnostic testing but may be reimbursed differently; some payers require physician supervision or referral for coverage, check each payer’s credentialing and coverage policies.

Medicare Part B typically recognizes audiologists for diagnostic testing under certain conditions; local policies and coverage LCDs can affect payment.

How to reduce common denials for 92502 (denial prevention checklist)

Audiologists can reduce common denials for 92502 by linking the procedure to a clear medical necessity, using accurate ICD-10 codes, and ensuring thorough documentation of test details. Verifying payer rules and securing any required authorizations before testing further protects reimbursement.  You can reduce denials by:

• Ensure medical necessity, link testing to an appropriate ICD-10 and clinical reason.
• Referrals/authorization: confirm preauthorization requirements where required.
• Correct provider, bill under a provider with appropriate credentials and enrollment.
• Accurate documentation: show thresholds, speech scores, equipment calibration.
• Avoid double billing: don’t separately bill bundled procedures unless payer allows.
• Timely filing and NPI/EIN info: make sure billing fields are correct.

How much can you expect to be reimbursed? (practice example estimates)

The numbers below are illustrative estimates only, actual payer and regional fee schedule rates vary widely. Always check each payer’s fee schedule.

How to use CPT 92502 in common clinical scenarios (with examples)

Scenario A — New adult with hearing complaints

Provider performs full pure-tone air and bone thresholds and speech recognition. Code 92502 — document findings and plan (ENT referral). Use ICD-10 H90.3. Bill per normal.

Scenario B — School screening fail

If patient failed screening and a diagnostic threshold test is performed, 92502 is usually appropriate; include reason for diagnostic testing (failed screening).

Scenario C — Occupational noise exposure monitoring

If test is part of occupational monitoring program (Acuity or regulatory program), coverage and payment may differ; employer-paid testing may be billed differently or collected as cash.

How to package 92502 with other visits or global services

When an evaluation visit includes counseling, medical assessment, or other billable E/M services, separate the testing from the E/M, document distinct components. Some payers allow concurrent billing for E/M + 92502 if both are medically necessary and distinctly documented; others may bundle. When billing both, include modifier and a clear justification.

How to interpret audiogram results and include them in the note

Include threshold tables (250–8000 Hz), PTA for speech frequencies (e.g., 500, 1k, 2k average), and narrative interpretation (type conductive/sensorineural/mixed; degree normal/mild/moderate/severe). Provide speech recognition scores with presentation level.

How to handle telehealth, remote, or outreach audiology

Pure tone audiometry is an in-person procedure. Remote or boothless testing has unique limitations and possible payer restrictions. If providing outreach or mobile testing, document setting, equipment, and calibration, and confirm payer acceptance.

How to prepare for an external audit focused on 92502

Maintain, calibration logs, test protocols, staff credentials, patient charts with full documentation (as shown earlier), and any referrals/authorizations. Provide clear chain-of-custody for records if requested.