How Much Does Medicare pay for 69210?

How Much Does Medicare pay for 69210?

CPT Code 69210 Removal impacted cerumen (separate procedure), 1 or both ears
Average Medicare Reimbursement Per Procedure** $33.88
Break Even (Procedures) 3.33

Does CPT code 69210 need a modifier?

Unilateral Procedure Additionally, the descriptor of 69210 has been clarified to reflect that the code is inherently unilateral. For bilateral impacted cerumen removal, report code 69210 with modifier 50, Bilateral Procedure, appended.

Can you bill an office visit with 69210?

Is it appropriate to bill the 99211 with the 69210? A. Since no physician work was required, you should not use code 69210. Instead, you would only bill 99211.

How Much Does Medicare pay for cerumen removal?

According to the Medicare physician fee schedule for 2020, the guide for what doctors may bill to original Medicare for their services, if approved, Medicare pays between $35 and $60 dollars for earwax removal.

Is 69210 covered by Medicare?

Medicare cannot reimburse audiologists for CPT code 69210 or HCPCS code G0268 under any circumstances.

How do you bill CPT 69210 bilateral?

A: The coder would report CPT code 69210 (removal impacted cerumen requiring instrumentation, unilateral) with modifier -50 (bilateral procedure) twice. Alternatively, the coder could report code 69210 twice with modifiers -LT (left side) and -RT (right side).

How do I bill 69210 Bilateral to Medicare?

Reporting 69210 Documentation should indicate the equipment used to provide the service. CPT® considers this procedure unilateral and states, “For bilateral procedure, report 69210 with modifier 50.” Contradictory to CPT®, Medicare considers this a bilateral procedure and prices it as such.

Can CPT code 69210 be billed with 50 modifier?

A: The coder would report CPT code 69210 (removal impacted cerumen requiring instrumentation, unilateral) with modifier -50 (bilateral procedure) twice. Coders should check with payers to ensure that there are no policies in place that would prohibit them from billing cerumen removal as a bilateral procedure.

Is cerumen removal covered by insurance?

For the most part, insurance companies and Medicare do not cover earwax removal. According to Medicare, there may be some exceptions if the patient is enrolled in a Medical Advantage plan which provides additional coverage for hearing care3.

How do I bill Medicare for 69210 bilateral?

Does CPT code 92504 need a modifier?

CPT 92504 is reported only once without modifier 50. Additionally, you probably don’t need modifier 25 on the E/M code to Medicare because there is not a National Correct Coding Initiative (NCCI) edit between the two codes which would warrant modifier 25.

Who can Bill 69210?

Historically, many payers have required a physician to provide the service. Some payers continue to observe this restriction, while others may allow an NPP (such as nurse practitioner, physician assistant, or clinical nurse specialist) to perform and report 69210.

Does CPT 69210 need to be reported with 92504?

Although the AAO-HNS recommends separately reporting 92504 with cerumen removal when using the binocular microscope, per CPT®, 92504 is a “separate procedure,” and most payers will bundle the visualization with 69210.

Is 69210 a good CPT code for cerumen removal?

Cerumen removal reporting done right. Some CPT® codes cause more than their share of confusion, and judging from the feedback we receive from Healthcare Business Monthly readers, one such code is 69210 Removal impacted cerumen requiring instrumentation, unilateral. Here’s the information you need to clear the confusion.

Is CPT 92504 used twice for the same examination?

Answer: No. CPT 92504 describes using a microscope for an examination – it represents payment for using a separate piece of equipment for your exam. The code is not reported twice, nor is modifier 50 appended, when both ears are examined. *This response is based on the best information available as of 12/14/17.

What is the billing and reimbursement for CPT codes 69210 and g0268?

Billing and reimbursement for CPT code 69210 or HCPCS code G0268 is limited to clinical circumstances where documentation supports these to be reasonable and necessary services requiring a physician’s skill.