92563
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
$35.74
Non-Facility
$35.74
Documentation Required
- All documentation must be maintained in the patient's medical record, be legible, include appropriate patient identification (e.g., full name) and dates of service, and be made available to the contractor upon request.
- The record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
- The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
- The IDTF must have Palmetto GBA provider enrollment approval listing the specific CPT/HCPCS codes the facility is authorized to bill for Medicare beneficiaries.
Key Coverage Criteria
- CPT codes 92553, 92557, and 92568 are allowable when the beneficiary has current long-term use of ototoxic antibiotics.
- The professional component (PC) of CPT codes 92537, 92538, 92541, 92542, 92544, 92545, 92546, 92587, 92588, 92651, 92652, and 92653 may be reported when the PC is performed in inpatient, outpatient, rehabilitation facilities, nursing facilities (when Part A benefits are exhausted), hearing and speech centers, independent clinics, or independent diagnostic testing facilities (IDTF).
- Technical-only CPT codes 92547, 92552, 92553, 92555, 92556, 92562, 92563, 92565, 92571, 92572, 92575, 92576, 92577, 92582, 92583, and 92584 may be reported when performed in office settings, clinics, hearing and speech centers, and nursing facilities.
- Payment for technical components of TC/PC services (when the PC is performed by an appropriate professional) and for technical-only services is allowed to hospitals.
- An IDTF must be credentialed and approved by Palmetto GBA provider enrollment to bill Medicare for a specific diagnostic procedure or material.
- Additional services and supplies (e.g., radiopharmaceuticals, special contrast agents, medications) are payable to an IDTF when the diagnostic test itself is payable and the supplies are commonly separately reimbursed to a physician in an office setting.
9 Active Policies
L33693 — Peripheral Venous Ultrasound
J09
A53252 — Billing and Coding: Independent Diagnostic Testing Facility (IDTF)
J12
L37371 — Electroretinography (ERG)
J12
L35451 — Peripheral Venous Ultrasound
J12
A57434 — Billing and Coding: Vestibular and Audiologic Function Studies
Related Codes
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