Billing and Coding: Vestibular Function Testing

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Vestibular Function
Testing L34537.

Appropriate ICD-10-CM codes must be submitted with each claim. Claims
submitted without such evidence will be denied as not medically necessary.

It is not enough to link the procedure code to a payable ICD-10-CM code. The
diagnosis or clinical suspicion must be present for the procedure to be paid,
and the patient's medical record must document that the coverage criteria in
this policy have been met. Covered services must meet general community
standards of appropriate medical care. For example, extremely mild symptoms of
very short duration may not justify procedures or testing, even though a
listed ICD-10-CM symptom might superficially be met. Inclusion of certain "not
otherwise specified" codes does not mean that any other associated disorder is
covered.

Repeat testing on a regular basis, in the absence of the resumption of
symptoms, is not warranted. A few conditions may require testing on multiple
days due to variably acute symptoms, such as benign positional vertigo, which
varies with inner ear canal stones. However, in this case, isolated testing
with CPT 92542 is usually sufficient, and within several episodes, a
diagnosis should be established.

CPT codes 92541 and 92542 are more likely to be medically necessary for
follow up of disorders, likely secondary to canal block pathology. For this
purpose, there may be testing at several visits, at intervals, for evaluation
of interval change and symptoms.

**Scope of Practice**

Diagnostic procedures 92541-92542 and 92544-92548 may be performed only by
licensed audiologists with a physician's order; by a licensed physician,
preferably with certification by the American Board of Medical Specialties in
Otolaryngology, Neurology or Otology/Neurology; or other providers licensed to
practice medicine under the personal supervision of an appropriate physician
as described in the Code of Federal Register (CFR).

**Basic Audiometry**

CPT code 92552 or 92553 will be covered if ordered and performed in
conjunction with VFT. CPT code 92557 will also be covered if ordered and
performed in conjunction with Vestibular Function Testing (VFT), instead of
CPT code 92553, when the speech recognition component of the CPT code 92557
is reasonable and necessary in the diagnosis or treatment of an individual
Medicare beneficiary (e.g., Vestibular Schwannoma). No other hearing tests
will be covered, when performed in conjunction with VFT for the diagnosis of
balance problems.

CPT code 92557 - This is a comprehensive audiometry evaluation, which
includes a battery of tests comprised both of the elements of threshold
evaluation (hearing threshold levels at various frequencies presented by both
air and bone conduction) and speech audiometry, including both speech
reception and speech recognition testing. CPT code 92557 includes the
elements of CPT codes 92553 and 92556; therefore, these codes cannot be
billed on the same date of service in addition to CPT code 92557.

**Summary**

CPT codes 92542, 92544, 92545, 92546, and 92548 are billable once per day,
and repeated analysis or confirmation of findings within the session is
considered part of 1 test. Note, for example, that CPT code 92542
specifically requires 4 or more positions tested in order to bill for 1 unit
(per CPT definition).

_CPT  code 92537 is intended to report a complete caloric vestibular testing
procedure that includes bilateral performance of bithermal irrigation (i.e.,
one warm and one cool irrigation for each ear). Fewer irrigation procedures
require a different method of reporting according to what was done. For 3
irrigations (e.g., irrigation of both ears using monothermal irrigation of 1
ear and bithermal irrigation of the contralateral ear), code 92537 and report
with modifier 52. Monothermal irrigation (i.e., irrigation of both ears with
either cool or warm irrigation) is reported once with CPT code 92538. If a
single ear is irrigated with a single method of irrigation (cool or warm) code
92538 is reported once with modifier 52,_ as described in the CPT Insiders
View January 2016.

CPT code 92547 may be billed multiple times as required by other medically
necessary tests. Since the same electrodes are typically used for several
serial tests, billing more than 6 per day would be atypical.

CPT codes 92531, 92532, 92533, and 92534 for vestibular function tests,
without electrical recording are considered bundled physical examination codes
by Centers for Medicare and Medicaid Services (CMS), have Relative Value Units
(RVU's) of zero, and are not payable.