CCSD code 20220 – Pure tone audiogram (air and bone conduction)

Key takeaways

CCSD code 20220 covers a pure tone audiogram that tests both air conduction and bone conduction, with masking included in the code.

An audiogram that tests air conduction only is billed as 20210, and an impedance audiogram is billed as 20230 or 20240.

The audiogram form should show air and bone conduction thresholds for each ear, plus which thresholds were masked.

Insurers set their own maximum for 20220: The Exeter lists £50 and Allianz Care’s UK schedule lists £70.

Check CCSD’s unacceptable combinations and the insurer’s authorization rules before adding a second code to the same invoice.

What CCSD code 20220 covers

CCSD code 20220 is the UK private insurance code for a pure tone audiogram that measures air conduction and bone conduction thresholds, with masking included.

The Exeter’s published fee schedule lists it as “Pure tone audiogram (air and bone conduction) – including masking.”

The Clinical Coding and Schedule Development group (CCSD) maintains the procedure schedule that UK private medical insurers use. Its technical guide places five-number investigation codes like 20220 in Chapter 1 of the procedural schedule. Some codes also sit in the diagnostic schedule, and CCSD files 20220 under Chapter 30, Audiology diagnostic.

Our CCSD code library collects billing guides for other codes in the schedule, including the audiology codes either side of 20220.

What each part of the descriptor means

The descriptor names three components, and the audiogram has to show all three to support the code:

• Pure tone audiogram: a chart of the quietest tone the patient can hear at each test frequency, plotted for each ear.
• Air conduction and bone conduction: air conduction tones travel through earphones. Bone conduction tones come from a vibrator placed on the mastoid, behind the ear.
• Including masking: masking noise keeps the ear not being tested from picking up the tone. The descriptor names it, so masking is part of the code rather than a separate charge.

How the 20220 audiogram is performed

The British Society of Audiology’s recommended procedure sets the standard method for both parts of the test. Air conduction comes first. The audiologist starts with the better-hearing ear at 1000 Hz, then tests 2000, 4000, 8000, 500 and 250 Hz.

Bone conduction follows, normally only between 500 Hz and 2000 Hz. Comparing the bone conduction thresholds with the air conduction thresholds shows whether a hearing loss is conductive, sensorineural or mixed. That comparison is the clinical reason to perform 20220 rather than an air-conduction-only test.

When masking is needed

The BSA procedure sets two rules for when the audiologist must mask the non-test ear:

• Air conduction: when the not-masked thresholds of the two ears differ by 40 dB or more with over-ear earphones. With insert earphones, the trigger is 55 dB.
• Bone conduction: when the not-masked bone conduction threshold is better than the air conduction threshold of either ear by 10 dB or more.

Choosing between 20210, 20220, 20230 and 20240

Four audiometry codes sit side by side in the schedule, and each descriptor names the components it covers. The matrix shows which code matches which test.

The impedance codes cover a different test entirely. Code 20230 is an impedance audiogram on its own, while 20240 covers an impedance audiogram performed as part of another procedure.

Use the test you documented to pick the code:

CCSD records unacceptable combinations, pairs of codes that should not be billed together, against each code on its website. The schedule search sits behind a CCSD login, so check the entry for 20220 before you add a second audiology code to an invoice.

Documentation that supports a 20220 claim

The record has to show the components the descriptor names. Following the BSA procedure’s recording rules, keep these on file for every 20220 claim:

• Air conduction thresholds for each ear at each frequency tested.
• Bone conduction thresholds, plus the mastoid the bone vibrator sat on when bone conduction was not masked.
• Which thresholds were masked, marked with the standard masked and not-masked audiogram symbols.
• Any change to the standard method, such as frequencies left out, with the reason.
• The insurer’s authorization number, where the insurer issued one before the appointment.

A structured audiogram form makes each item a field the audiologist completes during the test, rather than a note added afterward.

Insurer fees and authorization for 20220

Each insurer sets its own maximum benefit for 20220, so the fee depends on the patient’s policy. The Exeter lists £50 for the procedure and £0 for anesthesia. Allianz Care’s UK fee schedule, effective 2 December 2024, lists £70 for both 20210 and 20220.

The Exeter asks members to get the CCSD code from their specialist, then call to authorize the claim before any treatment. Other insurers set their own authorization rules, so confirm them with each one before the appointment.

Bupa publishes its codes through its code search tool. Our guide to Bupa CCSD codes explains how its schedule works, and the Bupa fee schedule guide covers how Bupa sets reference fees.

How Pabau supports CCSD 20220 billing

A 20220 claim draws on three records: the audiogram, the authorization and the invoice. When each lives in a different tool, the team rebuilds the link between them for every claim.

Pabau, the practice management platform we build, keeps all three on the patient record. Its claims management software sends UK claims through Healthcode and Bupa, and the claims dashboard tracks each one to payment.

The authorization code, its dates and the sessions it covers are tracked on the patient case. Pabau warns you when an authorization is missing, so you can catch it before the patient is tested.

Bill CCSD 20220 with the paperwork in place

Pabau keeps audiogram forms, authorization codes and insurer claims on one patient record, so your team submits 20220 claims with the evidence already attached.

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Conclusion

Bill 20220 only when the audiogram measured bone conduction as well as air conduction. If bone conduction was not tested, 20210 is the accurate code, and an impedance test belongs under 20230 or 20240.

Before you submit, check the insurer’s authorization rules and CCSD’s unacceptable combinations for 20220. That check takes minutes, while a returned claim costs a resubmission and a later payment. Book a demo to see how Pabau keeps audiogram records, authorizations and claims together for your audiology practice.

Continue your research

Billing an impedance audiogram on its own? CCSD code 20230 covers the standalone impedance audiogram and what to record for it.

Impedance test done during another procedure? CCSD code 20240 explains when the in-procedure impedance code applies.

Working with Bupa patients? Bupa CCSD codes explains how the Bupa code schedule works for private providers.

Need Bupa’s reference fees? Bupa procedure codes fee schedule covers how Bupa sets reference fees before you invoice.

Frequently asked questions