H81.391 — Other peripheral vertigo, 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.
- Vestibular function testing is covered when medically necessary to evaluate balance or suspected vestibular dysfunction and when other physiological, psychological, medication-related, or systemic causes of balance problems have been ruled out.
12 Active Policies
L35007 — Vestibular and Audiologic Function Studies
J12
A57434 — Billing and Coding: Vestibular and Audiologic Function Studies
J12
AETNA-CPB-0697 — Intraoperative Neurophysiological Monitoring
A56497 — Billing and Coding: Vestibular Function Testing
A57118 — Billing and Coding: Vestibular Function Tests
Related Codes
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