The following table lists the CPT procedure codes for audiology services covered under the BadgerCare Plus Standard Plan and under the BadgerCare Plus Benchmark Plan for members 17 years of age and younger:
Procedure Code | Description | Copayment | Prior Authorization Required | Daily Service Limit | Maximum Allowable Fee |
---|---|---|---|---|---|
69210 |
Removal impacted cerumen (separate procedure), one or both ears |
Standard Plan: N/A. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit |
No |
1 |
$25.75 |
92504 |
Binocular microscopy (separate diagnostic procedure) |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$23.86 |
92506 |
Evaluation of speech, language, voice, communication, and/or auditory processing |
Standard Plan: $3.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
PA after initial SOI |
1 |
$57.19 |
92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
PA after initial SOI |
1 |
$45.18 |
92508 |
Group, two or more individuals |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
PA after initial SOI |
1 |
$26.68 |
92511 |
Nasopharyngoscopy with endoscope (separate procedure) |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$47.12 |
92512 |
Nasal function studies (eg, rhinomanometry) |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$36.38 |
92516 |
Facial nerve function studies (eg, electroneuronography) |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$26.07 |
92520 |
Laryngeal function studies (ie, aerodynamic testing and acoustic testing) |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$29.58 |
92526 |
Treatment of swallowing dysfunction and/or oral function for feeding |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$46.49 |
92531 |
Spontaneous nystagmus, including gaze |
Standard Plan: $3.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$57.53 |
92532 |
Positional nystagmus test |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$37.12 |
92533 |
Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests) |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$24.22 |
92534 |
Optokinetic nystagmus test |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$42.06 |
92541 |
Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$34.67 |
92542 |
Positional nystagmus test, minimum of 4 positions, with recording |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$30.70 |
92543 |
Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests), with recording |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$39.29 |
92544 |
Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$23.77 |
92545 |
Oscillating tracking test, with recording |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$20.46 |
92546 |
Sinusoidal vertical axis rotational testing |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$26.42 |
92547 |
Use of vertical electrodes (List separately in addition to code for primary procedure) |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$18.16 |
92548 |
Computerized dynamic posturography |
Standard Plan: $3.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$77.91 |
92550 |
Tympanometry and reflex threshold measurements |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$17.64 |
92551 |
Screening test, pure tone, air only |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$12.56 |
92552 |
Pure tone audiometry (threshold); air only |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$16.41 |
92553 |
air and bone |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$23.11 |
92555 |
Speech audiometry threshold; |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$14.51 |
92556 |
with speech recognition |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$21.34 |
92557 |
Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined) |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$38.18 |
92559 |
Audiometric testing of groups |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$21.98 |
92560 |
Bekesy audiometry; screening |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$17.78 |
92561 |
diagnostic |
Standard Plan: $.50. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$7.18 |
92562 |
Loudness balance test, alternate binaural or monaural |
Standard Plan: $.50. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$8.31 |
92563 |
Tone decay test |
Standard Plan: $.50. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$9.17 |
92564 |
Short increment sensitivity index (SISI) |
Standard Plan: $.50. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$8.33 |
92565 |
Stenger test, pure tone |
Standard Plan: $.50. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$9.00 |
92567 |
Tympanometry (impedance testing) |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$17.03 |
92568 |
Acoustic reflex testing; threshold |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$12.94 |
92570 |
Acoustic immittance testing, includes tympanometry (impedance testing) acoustic reflex threshold testing, and acoustic reflex decay testing |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$26.87 |
92571 |
Filtered speech test |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$28.94 |
92572 |
Staggered spondaic word test |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$17.35 |
92575 |
Sensorineural acuity level test |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$17.35 |
92576 |
Synthetic sentence identification test |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$17.35 |
92577 |
Stenger test, speech |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$14.48 |
92579 |
Visual reinforcement audiometry (VRA) |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$25.29 |
92582 |
Conditioning play audiometry |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$15.07 |
92583 |
Select picture audiometry |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$15.29 |
92584 |
Electrocochleography |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$49.56 |
92585 |
Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive |
Standard Plan: $3.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$151.03 |
92586 |
limited |
Standard Plan: $3.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$60.62 |
92587 |
Evoked otoacoustic emissions; limited (single stimulus level, either transient or distortion products) |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$49.53 |
92588 |
Comprehensive or diagnostic evaluation (comparison of transient and/or distortion product otoacoustic emissions at multiple levels and frequencies) |
Standard Plan: $3.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$68.33 |
92590 |
Hearing aid examination and selection; monaural |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$22.93 |
92591 |
Binaural |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$25.41 |
92592 |
Hearing aid check; monaural |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$15.38 |
92593 |
Binaural |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$19.40 |
92594 |
Electroacoustic evaluation for hearing aid; monaural |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$11.39 |
92595 |
Binaural |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$14.36 |
92596 |
Ear protector attenuation measurements |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$10.36 |
92597 |
Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech |
Standard Plan: $3.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$72.33 |
92601 |
Diagnostic analysis of cochlear implant, patient under 7 years of age; with programming |
Standard Plan: $3.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$112.20 |
92602 |
Subsequent reprogramming |
Standard Plan: $3.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$76.90 |
92603 |
Diagnostic analysis of cochlear implant, age 7 years or older; with programming |
Standard Plan: $3.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$69.32 |
92604 |
Subsequent reprogramming |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$49.43 |
92607 |
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour |
Standard Plan: $3.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$60.57 |
92608 |
each additional 30 minutes (List separately in addition to code for primary procedure) |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$30.29 |
92609 |
Therapeutic services for the use of speech-generating device, including programming and modification |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$145.37 |
92610 |
Evaluation of oral and pharyngeal swallowing function |
Standard Plan: $3.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$68.78 |
92611 |
Motion fluoroscopic evaluation of swallowing function by cine or video recording |
Standard Plan: $3.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$111.35 |
92612 |
Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording |
Standard Plan: $3.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$132.47 |
92614 |
Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording |
Standard Plan: $3.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$124.41 |
92620 |
Evaluation of central auditory function, with report; initial 60 minutes |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$37.55 |
92621 |
Each additional 15 minutes |
Standard Plan: $.50. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
2 |
$9.50 |
92625 |
Assessment of tinnitus (includes pitch, loudness matching, and masking) |
Standard Plan: $2.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$36.92 |
92626 |
Evaluation of auditory rehabilitation status; first hour |
Standard Plan: $3.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$65.40 |
92627 |
Each additional 15 minutes (List separately in addition to code for primary procedure) |
Standard Plan: $1.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
2 |
$16.35 |
92630 |
Auditory rehabilitation; pre-lingual hearing loss |
Standard Plan: $3.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$75.95 |
92633 |
Post-lingual hearing loss |
Standard Plan: $3.00. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
No |
1 |
$75.95 |
92700 |
Unlisted otorhinolaryngological service or procedure |
Standard Plan: Based on pricing for procedure. Benchmark Plan: $15.00 per visit, regardless of number of procedures performed during the visit. |
Yes |
N/A |
Manually Priced |