LCD/NCD Portal

L29299 TYMPANOMETRY

 

 

02/02/2009

 

 

Indications and Limitations of Coverage and/or Medical Necessity

 

• For Medicare coverage of audiologists performing hearing tests, the audiologists must be “qualified audiologists” as defined in the Medicare Benefit Policy Manual, Section 80.3.

o A qualified audiologist is an individual with a master’s or doctoral degree in audiology.

o Therefore, a Doctor of Audiology (AuD) 4th year student with a provisional license from a State does not qualify unless he or she also holds a master's or doctoral degree in audiology.

o In addition, a qualified audiologist is an individual who:

 Is licensed as an audiologist by the State in which the individual furnishes such services; or

 In the case of an individual who furnishes services in a State which does not license audiologists, has

• Successfully completed 350 clock hours of supervised clinical practicum (or is in the process of accumulating such supervised clinical experience),

• Performed not less than 9 months of supervised full-time audiology services after obtaining a master’s degree or doctoral degree in audiology or a related field, and

• Successfully completed a national examination in audiology approved by the secretary.

• Medicare will consider tympanometry reasonable and medically necessary when testing for the purpose of obtaining additional information necessary for his/her evaluation of the need for or appropriate type of medical or surgical treatment of a hearing deficit or other medical problem.

• The following are indications considered reasonable and medically necessary:

o To evaluate middle ear abnormalities suspected by clinical otoscopy

o To evaluate Eustachian tube patency

o To evaluate conductive hearing loss

o To evaluate perforations of the tympanic membrane

o To evaluate suspected fixation of the ossicular chain

o To evaluate middle ear function

o To evaluate lack of contact between conduction of the bones of the middle ear

o To document or follow persistent middle ear effusions

• If a physician refers a beneficiary to an audiologist for testing related to signs or symptoms associated with hearing loss, balance disorder, tinnitus, ear disease or ear injury, the audiologist’s diagnostic testing services should be covered, even if the only outcome is the prescription of a hearing aid.

o If a beneficiary undergoes diagnostic testing performed by an audiologist without a physician order, then these tests are not covered, even if the audiologist discovers a pathologic condition.

 

 

CPT/HCPCS Codes

 

92567 TYMPANOMETRY (IMPEDANCE TESTING)

 

 

ICD-9 Codes that Support Medical Necessity

 

381.00 ACUTE NONSUPPURATIVE OTITIS MEDIA UNSPECIFIED

381.01 ACUTE SEROUS OTITIS MEDIA

381.02 ACUTE MUCOID OTITIS MEDIA

381.03 ACUTE SANGUINOUS OTITIS MEDIA

381.04 ACUTE ALLERGIC SEROUS OTITIS MEDIA

381.05 ACUTE ALLERGIC MUCOID OTITIS MEDIA

381.06 ACUTE ALLERGIC SANGUINOUS OTITIS MEDIA

381.10 CHRONIC SEROUS OTITIS MEDIA SIMPLE OR UNSPECIFIED

381.19 OTHER CHRONIC SEROUS OTITIS MEDIA

381.20 CHRONIC MUCOID OTITIS MEDIA SIMPLE OR UNSPECIFIED

381.29 OTHER CHRONIC MUCOID OTITIS MEDIA

381.3 OTHER AND UNSPECIFIED CHRONIC NONSUPPURATIVE OTITIS MEDIA

381.4 NONSUPPURATIVE OTITIS MEDIA NOT SPECIFIED AS ACUTE OR CHRONIC

381.50 EUSTACHIAN SALPINGITIS UNSPECIFIED

381.51 ACUTE EUSTACHIAN SALPINGITIS

381.52 CHRONIC EUSTACHIAN SALPINGITIS

381.60 OBSTRUCTION OF EUSTACHIAN TUBE UNSPECIFIED

381.61 OSSEOUS OBSTRUCTION OF EUSTACHIAN TUBE

381.62 INTRINSIC CARTILAGENOUS OBSTRUCTION OF EUSTACHIAN TUBE

381.63 EXTRINSIC CARTILAGENOUS OBSTRUCTION OF EUSTACHIAN TUBE

381.7 PATULOUS EUSTACHIAN TUBE

381.81 DYSFUNCTION OF EUSTACHIAN TUBE

381.89 OTHER DISORDERS OF EUSTACHIAN TUBE

381.9 UNSPECIFIED EUSTACHIAN TUBE DISORDER

382.00 ACUTE SUPPURATIVE OTITIS MEDIA WITHOUT SPONTANEOUS RUPTURE OF EARDRUM

382.01 ACUTE SUPPURATIVE OTITIS MEDIA WITH SPONTANEOUS RUPTURE OF EARDRUM

382.02 ACUTE SUPPURATIVE OTITIS MEDIA IN DISEASES CLASSIFIED ELSEWHERE

382.1 CHRONIC TUBOTYMPANIC SUPPURATIVE OTITIS MEDIA

382.2 CHRONIC ATTICOANTRAL SUPPURATIVE OTITIS MEDIA

382.3 UNSPECIFIED CHRONIC SUPPURATIVE OTITIS MEDIA

382.4 UNSPECIFIED SUPPURATIVE OTITIS MEDIA

382.9 UNSPECIFIED OTITIS MEDIA

383.00 ACUTE MASTOIDITIS WITHOUT COMPLICATIONS

383.01 SUBPERIOSTEAL ABSCESS OF MASTOID

383.02 ACUTE MASTOIDITIS WITH OTHER COMPLICATIONS

383.1 CHRONIC MASTOIDITIS

383.20 PETROSITIS UNSPECIFIED

383.21 ACUTE PETROSITIS

383.22 CHRONIC PETROSITIS

383.30 POSTMASTOIDECTOMY COMPLICATION UNSPECIFIED

383.31 MUCOSAL CYST OF POSTMASTOIDECTOMY CAVITY

383.32 RECURRENT CHOLESTEATOMA OF POSTMASTOIDECTOMY CAVITY

383.33 GRANULATIONS OF POSTMASTOIDECTOMY CAVITY

383.81 POSTAURICULAR FISTULA

383.89 OTHER DISORDERS OF MASTOID

383.9 UNSPECIFIED MASTOIDITIS

384.00 ACUTE MYRINGITIS UNSPECIFIED

384.01 BULLOUS MYRINGITIS

384.09 OTHER ACUTE MYRINGITIS WITHOUT OTITIS MEDIA

384.1 CHRONIC MYRINGITIS WITHOUT OTITIS MEDIA

384.20 PERFORATION OF TYMPANIC MEMBRANE UNSPECIFIED

384.21 CENTRAL PERFORATION OF TYMPANIC MEMBRANE

384.22 ATTIC PERFORATION OF TYMPANIC MEMBRANE

384.23 OTHER MARGINAL PERFORATION OF TYMPANIC MEMBRANE

384.24 MULTIPLE PERFORATIONS OF TYMPANIC MEMBRANE

384.25 TOTAL PERFORATION OF TYMPANIC MEMBRANE

384.81 ATROPHIC FLACCID TYMPANIC MEMBRANE

384.82 ATROPHIC NONFLACCID TYMPANIC MEMBRANE

384.9 UNSPECIFIED DISORDER OF TYMPANIC MEMBRANE

386.11 BENIGN PAROXYSMAL POSITIONAL VERTIGO

386.12 VESTIBULAR NEURONITIS

386.19 OTHER PERIPHERAL VERTIGO

386.2 VERTIGO OF CENTRAL ORIGIN

386.30 LABYRINTHITIS UNSPECIFIED

386.31 SEROUS LABYRINTHITIS

386.32 CIRCUMSCRIBED LABYRINTHITIS

386.33 SUPPURATIVE LABYRINTHITIS

386.34 TOXIC LABYRINTHITIS

386.35 VIRAL LABYRINTHITIS

387.0 OTOSCLEROSIS INVOLVING OVAL WINDOW NONOBLITERATIVE

387.1 OTOSCLEROSIS INVOLVING OVAL WINDOW OBLITERATIVE

387.2 COCHLEAR OTOSCLEROSIS

387.8 OTHER OTOSCLEROSIS

387.9 OTOSCLEROSIS UNSPECIFIED

388.30 TINNITUS UNSPECIFIED

388.31 SUBJECTIVE TINNITUS

388.32 OBJECTIVE TINNITUS

389.00 CONDUCTIVE HEARING LOSS UNSPECIFIED

389.01 CONDUCTIVE HEARING LOSS EXTERNAL EAR

389.02 CONDUCTIVE HEARING LOSS TYMPANIC MEMBRANE

389.03 CONDUCTIVE HEARING LOSS MIDDLE EAR

389.04 CONDUCTIVE HEARING LOSS INNER EAR

389.05 CONDUCTIVE HEARING LOSS, UNILATERAL

389.06 CONDUCTIVE HEARING LOSS, BILATERAL

389.08* CONDUCTIVE HEARING LOSS OF COMBINED TYPES

389.10 SENSORINEURAL HEARING LOSS UNSPECIFIED

389.11 SENSORY HEARING LOSS, BILATERAL

389.12 NEURAL HEARING LOSS, BILATERAL

389.13 NEURAL HEARING LOSS, UNILATERAL

389.14 CENTRAL HEARING LOSS

389.15 SENSORINEURAL HEARING LOSS, UNILATERAL

389.16 SENSORINEURAL HEARING LOSS, ASYMMETRICAL

389.17 SENSORY HEARING LOSS, UNILATERAL

389.18 SENSORINEURAL HEARING LOSS, BILATERAL

389.20 MIXED HEARING LOSS, UNSPECIFIED

389.21 MIXED HEARING LOSS, UNILATERAL

389.22 MIXED HEARING LOSS, BILATERAL

* Tests for the ICD-9 codes 389.00-389.08 are covered only for an initial evaluation of a hearing problem.

 

 

Documentation Requirements

 

• Medical record documentation maintained by the performing physician must clearly indicate the medical necessity of the services being billed.

• In addition, documentation that the service was performed must be included in the patient’s medical record.

• The medical record should include the name and professional identity of the person who ordered and the person who performed the service.

• This information is normally found in the office/progress notes, hospital notes, and/or procedure report.

Treatment Logic

• Tympanometry is a test used to evaluate the condition of the middle ear system.

• The test determines the functionality of the tympanic membrane by observing its response to waves of pressure, and measuring the pressure of the middle ear.

• The test is used to measure parameters of the middle ear and eardrum in an effort to determine whether there are dysfunctions that could ultimately affect the hearing of the patient or put one at risk for repeated infections.

• Tympanometry is regarded as an objective technique for obtaining reproducible measurements of the compliance (also referred to as “admittance”) or mobility of the tympanic membrane and the pressure within the middle ear system.

• The measurements assist in assessing Eustachian tube function and in determining the continuity and mobility of the ossicular chain.

 

 

Sources of Information and Basis for Decision

 

Audiology services-communication disorders-Auburn University. Tympanometry & acoustic reflex testing. Retrieved on May 1, 2002 from: http://frontpage.auburn.edu/communication_disorders/audiotempa.asp?file=tart.txt This source defines tympanometry and acoustic reflex testing from an audiology perspective.

 

Green, L.A., Culpepper, L. & DeMelker, R.A. (2000). Tympanometry interpretation by primary care physicians. [On-line]. Retrieved April 2, 2001 from: http://www.ahcpr.gov/research/jan01/101RA18.htm This source provides the definition of the procedure.

 

Howard, M.L. (2001). Middle ear, tympanic membrane, perforations from otolaryngology and facial plastic surgery/middle ear. [On-line]. Retrieved April 2, 2001 from: http://www.emedicine.com/ent/topic206.htm This source provides definitions and appropriate indications for the procedure.

 

Nussbaum, D. (2000). Understanding the audiological evaluation. [On-line]. Retrieved April 2, 2001 from: http://clerccenter.gallaudet.edu/SupportServices/series/5002.html This source provides definitions of the procedure and other audiology examinations as well as test implications and contraindications for use of tympanometry.

 

Petrek, M.R. (2000). Integrating physiologic technologies for hearing evaluation in infants and small children: an overview. Retrieved May 28, 2002 from: http://www.audiology online.com/audiology/newroot/articles/arc_disp.asp?catid=4&id=217 This source provides descriptions and indications of tympanometry from an audiology perspective.

 

Walsh, M. (2001). Otitis media from emergency medicine/ear, nose and throat. [On-line]. Retrieved April 2, 2001, from: http://www.emedicine.com/emerg/topic351.htm This source provided support for the contraindications of use of the procedure.

 

02/02/2009

The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

 

AMA CPT / ADA CDT Copyright Statement

 

CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

 

CMS LCD TYMPANOMETRY