H81.399 — Other peripheral vertigo, unspecified ear
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- A valid order from the treating physician or non-physician practitioner is required (per CFR Title 42 §410.32(a)) and the ordering physician must appear on the audiologist claim.
- The medical record must be legible, include patient identification and dates of service, and contain the legible signature of the responsible physician or non-physician practitioner.
- The submitted medical record must support the selected ICD-10-CM diagnosis code(s) and must indicate that the billed CPT/HCPCS code accurately describes the service performed.
- A recording of the vestibular test must be obtained at the time of service, retained in the medical record, and made available upon request; the procedure report alone is insufficient to establish medical necessity.
Key Coverage Criteria
- 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.
- CPT 92537 (caloric vestibular testing) is intended for a complete caloric test consisting of bilateral bithermal irrigations (one warm and one cool irrigation for each ear).
- CPT 92538 (monothermal irrigation) is used when both ears are irrigated with the same temperature (monothermal) and reported once for that bilateral monothermal procedure.
- 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.
9 Active Policies
L35007 — Vestibular and Audiologic Function Studies
J12
A57434 — Billing and Coding: Vestibular and Audiologic Function Studies
J12
AETNA-CPB-0571 — Endolymphatic Hydrops (Meniere's Disease) Tests
AETNA-CPB-0612 — Hearing Aids
AETNA-CPB-0697 — Intraoperative Neurophysiological Monitoring
Related Codes
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