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92564
Quick jump to procedure code: Printer Friendly Version
92567

CPT® 92565: STENGER TEST, PURE TONE

Short Description: Stenger test pure tone

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
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DIST of COL-DC + MD/VA Suburbs
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2016 Physician
Fee Schedule:

Global Fee $ 16.12

2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 October Unadjusted OPPS Payment $ 30.51


*Based on National 2013 Medicare Part B submitted claims.
2016 APC Code: 5732
Level 2 Minor Procedures

2016 OPPS Status Indicator: Q1

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
PercentageICD-9ICD-10 Conversions
11.8% 388.31    Subjective tinnitus H93.19   Tinnitus, unspecified ear
11.8% 389.11    Sensory hearing loss, bilateral H90.3   Sensorineural hearing loss, bilateral
10.1% 389.10    Sensorineural hearing loss, unspecified H90.5   Unspecified sensorineural hearing loss
9.2% 389.16    Sensorineural hearing loss, asymmetrical H90.5   Unspecified sensorineural hearing loss
9.2% 389.20    Mixed hearing loss, unspecified H90.8   Mixed conductive and sensorineural hearing loss, unspecified
5.0% 300.11    Conversion disorder F44.4   Conversion disorder with motor symptom or deficit
OR:
F44.6   Conversion disorder with sensory symptom or deficit
4.2% 388.30    Tinnitus, unspecified H93.19   Tinnitus, unspecified ear
4.2% 389.00    Conductive hearing loss, unspecified H90.2   Conductive hearing loss, unspecified
4.2% 389.18    Sensorineural hearing loss, bilateral H90.3   Sensorineural hearing loss, bilateral
4.2% 780.4    Dizziness and giddiness R42   Dizziness and giddiness

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

92565 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 92565

CCI and MUE Edits*         Hide this section.

CCI Edits for 92565
Denied Codes (1)
Effective
Modifier
Accepted (2)
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
69209 Remove impacted ear wax uni
01/01/2016 No
69210 Remove impacted ear wax uni
06/05/2000 No
92601 Cochlear implt f/up exam <7
10/01/2004 No
92602 Reprogram cochlear implt 7/>
10/01/2004 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
92603 Cochlear implt f/up exam 7/>
10/01/2004 No
92604 Reprogram cochlear implt 7/>
10/01/2004 No
92640 Aud brainstem implt programg
04/01/2008 Yes
G0153 Hhcp-svs of s/l path,ea 15mn
07/01/2001 Yes
G0161 Hhc slp ea 15 min
07/01/2011 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 92565.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 92565


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 2 Date of Service Edit: Policy 2 Date of Service Edit: Policy Not Listed
Rationale: Nature of Service/Procedure Nature of Service/Procedure Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   92565 Top 5 Ordering Providers National*
MARK GACEK -MOBILE,AL 555
FREDERICK RUFFEN -GLEN COVE,NY 108
ALICE CHAN -NEW YORK,NY 69
ELIZABETH ROBERTS -FOLEY,AL 66
JOSE SANCHEZ-MENDIOLA -BAYAMON,PR 55

*Based on 2014 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 92565*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2015: 2,528
Total Services Denied 2015: 610 (24.1%)
National Charges Submitted 2015: $ 91,389.00
National Charges Allowed 2015: $ 28,186.00
National Average (No Modifier) Fee Submitted 2015: $ 36.54
National Average (No Modifier) Fee Allowed 2015: $ 14.70


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Audiologist
(billing independently)
1,300 51.4% $ 37.91 446 34.3%
Otolaryngology 1,187 47.0% $ 33.45 158 13.3%
Internal medicine 12 0.5% $ 38.95 0 0.0%
Neurology 12 0.5% $113.08 1 8.3%
Family practice 6 0.2% $ 25.00 0 0.0%

Top 5 Places of Service 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 2,522 99.8% $ 36.18 605 24.0%
Outpatient hospital 5 0.2% $ 29.62 5 100.0%
Nursing facility 1 0.0% $ 20.18 0 0.0%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 2,426 96.0% $ 36.54 561 23.1%
59 - Distinct Procedural Service 40 1.6% $ 35.18 10 25.0%
GA - Advanced Beneficiary Notice (ABN) on File 31 1.2% $ 12.05 27 87.1%
XU 9 0.4% $ 24.00 4 44.4%
AQ 4 0.2% $ 60.00 2 50.0%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.
12/07/2016 12:20:31 54.167.149.128

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