H66.016 — Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, bilateral
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
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.
- A physician referral is required for coverage of audiologist diagnostic tests; documentation of the referral must be present in the medical record.
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.
- Vestibular function tests and diagnostic audiometric tests are covered when performed to determine appropriate medical or surgical treatment for disorders of auditory, balance, or other neural systems.
- Pure tone audiometry (air and bone), comprehensive hearing testing and acoustic reflex testing are covered for patients on continuing long-term (>14 days) use of ototoxic antibiotics (e.g., streptomycin, aminoglycosides) for ototoxicity monitoring.
2 Active Policies
A57434 — Billing and Coding: Vestibular and Audiologic Function Studies
J12
L35007 — Vestibular and Audiologic Function Studies
J12
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.