Audiologist specialists in the USA are using CPT code 92502 to report a diagnostic hearing evaluation that determines hearing thresholds by pure-tone air conduction and bone conduction testing. If speech recognition (speech audiometry) is performed as part of the same session, it is typically bundled into 92502 and not reported separately unless a separate, billable speech test with a separate CPT exists and payer allows.
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.
Experienced audiologist in the USA knows that good documentation supports reimbursement and reduces denials. At a minimum, include:
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.)
CPT Code | Short description | Relationship to 92502 |
92502 | Pure tone audiometry threshold, air and bone (with speech recognition when performed) | Primary diagnostic threshold test |
92504 | Tympanometry and reflex threshold | Often billed separately when performed same visit (check bundling) |
92507 | Acoustic reflex testing | May be billed separately; bundling varies |
92521-92524 | Spontaneous/evoked otoacoustic emissions | Separate codes; may be billed in same visit |
92626 / 92627 | Evaluation of speech perception in hearing-impaired individuals | Separate, advanced speech testing — may be reported in addition if not bundled |
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:
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.
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:
The numbers below are illustrative estimates only, actual payer and regional fee schedule rates vary widely. Always check each payer’s fee schedule.
Payer Type | Typical allowed range (estimate) |
Medicare (estimate) | $25 – $50 |
Commercial Insurer (estimate) | $40 – $120 |
Self-pay / cash price (practice set) | $75 – $200 |
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.
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.
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.
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.
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.
Contact Preferred MB today to streamline your telehealth medical billing and secure your revenue in 2025 and beyond.
Thank you for your interest in Preferred MB, a premier U.S. medical billing service provider. We are excited to connect with you. Let’s get in touch and explore how we can best meet your needs.