Billing and Coding: Cerumen (Earwax) Removal

This billing and coding guidance for cerumen (earwax) removal emphasizes documentation and claims requirements rather than clinical coverage criteria. Claims must include a valid ICD-10-CM diagnosis code, appropriate referring/order NPI when required, and detailed signed medical records; ABN rules (modifiers GA, GX, GZ, GY) and Part A-specific requirements (Form CMS-R-131, occurrence code 32, bill type 77X for FQHCs) determine financial liability and automatic denials. Providers must also follow NCCI and OPPS edits and notify beneficiaries in writing when services may not be covered.

"A claim submitted without a valid ICD-10-CM diagnosis code will be returned as an incomplete claim under Section 1833(e) of the Social Security Act."

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