H81.01 — Meniere's disease, right ear
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Claims must include appropriate ICD-10-CM diagnosis codes and the medical record must document the diagnosis or clinical suspicion, relevant signs/symptoms, and that coverage criteria were met.
- A physician's order is required for VFT performed by licensed audiologists.
- Documentation must record test-specific details (e.g., number of positions tested for CPT 92542; type and laterality of irrigations for CPT 92537/92538 and any use of modifier 52; justification for CPT 92557's speech recognition component; and electrode use/serial testing for CPT 92547).
- Claims and testing must comply with the Local Coverage Determination L34537 and applicable CFR supervision requirements.
Key Coverage Criteria
- Monothermal irrigation (CPT 92538) is covered when both ears are irrigated with the same temperature (cool or warm).
- Vestibular diagnostic procedures (CPT 92541-92542, 92544-92548) are covered when an appropriate ICD-10-CM diagnosis or clinical suspicion for vestibular dysfunction is documented in the medical record and the test is ordered and performed by an authorized provider.
- Basic audiometry (CPT 92552 or CPT 92553) is covered when ordered and performed in conjunction with vestibular function testing (VFT).
- Comprehensive audiometry (CPT 92557) is covered when ordered and performed in conjunction with VFT or instead of CPT 92553 when speech recognition testing is reasonable and necessary (e.g., vestibular schwannoma).
- Complete caloric vestibular testing (CPT 92537) is covered when bilateral bithermal irrigation (one warm and one cool irrigation per ear) is performed.
- Neurophysiology Evoked Potentials (NEPs) — including Somatosensory Evoked Potentials (SEPs), Brainstem Auditory Evoked Potentials (BAEPs/BAERs), and Visual Evoked Potentials (VEPs/VERs) — are covered when determined to be reasonable and necessary in accordance with LCD L34975.
20 Active Policies
L35753 — Non-Invasive Cerebrovascular Studies
J05
A57592 — Billing and Coding: Non-Invasive Cerebrovascular Studies
J05
A56773 — Billing and Coding: Neurophysiology Evoked Potentials (NEPs)
J12
L34975 — Neurophysiology Evoked Potentials (NEPs)
J12
L35007
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