CPT code 92552 – Pure tone audiometry, air conduction

Key takeaways

CPT code 92552 covers diagnostic pure tone air conduction audiometry only. Bone conduction and speech testing are excluded and need separate codes.

92552 cannot be billed on the same date as 92557: The comprehensive battery includes 92552, so billing both is an unbundling violation under NCCI edits.

Medicare covers 92552 only when a physician orders it for diagnostic purposes, and a signed order must be in the chart before billing.

Pabau’s claims management software flags bundling conflicts and missing physician orders before submission, so fewer 92552 claims come back denied.

CPT code 92552: Official descriptor and procedure overview

CPT code 92552 describes pure tone audiometry (threshold), air conduction only. The American Medical Association defines the service as measuring hearing thresholds across a range of test frequencies. The tones are air-conducted and delivered through supra-aural or insert earphones. The code does not include bone conduction, speech audiometry, or masking beyond what reliable air conduction thresholds require.

The code is appropriate for both unilateral and bilateral testing within a single encounter. Audiologists, otolaryngologists, and other qualified providers can bill 92552. Medicare and many commercial payers add supervision and physician-order requirements, which are covered later in this guide.

• Code range: 92552 falls within the Medicine section of the AMA CPT codebook, under Special Otorhinolaryngologic Services and Procedures (92502-92700), specifically Audiologic Function Tests (92550-92597)
• Service type: Diagnostic (not screening)
• Air conduction frequencies tested: Typically 250, 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz
• Provider types: Audiologist, ENT physician, and other qualified hearing professionals
• Global period: None (000, same-day billing permitted)

What CPT 92552 includes and excludes

The scope of 92552 is narrower than many coders assume. Knowing exactly what the code covers prevents both under-coding (missing billable services) and over-coding (bundling violations).

CPT 92552 vs 92551: Screening vs diagnostic audiometry

The most common coder error in audiology billing is selecting the screening code 92551 when diagnostic 92552 is clinically appropriate. The distinction matters for both reimbursement and audit risk.

Use 92551 only when the clinical intent is a pass/fail screen with no threshold measurement. Any encounter that produces a complete audiogram documenting decibel thresholds at discrete frequencies is 92552, regardless of whether the patient “passes.”

CPT 92552 vs 92557: When to bill each code

The comprehensive audiometry battery, 92557, is an all-inclusive code: It bundles pure tone air conduction, bone conduction, and speech audiometry into one reportable service. Billing CPT code 92552 on the same date as 92557 is an NCCI unbundling violation.

The CMS National Correct Coding Initiative (NCCI) edits flag 92552 and 92557 as a column 1/column 2 pair. Modifier -59 cannot override this edit, because 92557 contains 92552 by definition. Submitting both on the same claim will result in 92552 being denied or bundled into 92557.

The decision flow below puts 92551, 92552 and 92557 side by side, then lists the same-day checks that apply to a 92552 claim.

Companion codes: Billing 92552 with 92567 and other audiology codes

Several audiology codes can legitimately appear on the same date of service as CPT code 92552. The table below shows the most common pairings, whether an NCCI conflict exists, and when a modifier is needed.

ICD-10 diagnosis codes that support CPT 92552

Payers require a medically necessary diagnosis to support every billable claim. Selecting the wrong ICD-10 code is one of the top denial triggers for 92552. It happens most often when the screening code Z01.10 is submitted in place of a symptom or condition code for a diagnostic encounter.

When 92552 monitors a known sensorineural loss, such as after ototoxic medication, H90.5 is the usual supporting code. Pick the laterality-specific code instead once the chart confirms which ear is affected.

Avoid submitting Z01.10 (encounter for examination of ears and hearing) as the primary diagnosis on a 92552 claim for Medicare or most commercial payers. That code signals a screening encounter and will trigger a medical necessity denial on a diagnostic claim.

Medicare coverage and reimbursement for CPT code 92552

Medicare covers CPT code 92552 when a physician or other treating practitioner orders the service for diagnostic purposes. The order is a hard coverage condition under the Medicare Benefit Policy Manual, Chapter 15. Audiologists billing Medicare must have a physician order in the chart before the service is performed.

• Physician order: Required. Must be in the chart before billing. Most MACs treat a verbal or standing order as insufficient, so obtain a signed written order.
• Provider type: Audiologists bill under their own NPI with the audiology specialty code. ENT physicians may bill incident-to or under their own NPI.
• Place of service: Non-facility (office) rates are higher than facility rates. Confirm the POS code before submission. Billing POS 11 when the service was delivered in a hospital outpatient department is a common audit trigger.
• Reimbursement: Payment rates are RVU-based and change annually. Verify current payment amounts using the CMS Physician Fee Schedule lookup tool. Dollar figures cited in secondary sources may be out of date.
• LCD reference: Applicable Local Coverage Determinations vary by Medicare Administrative Contractor. Review the LCD for your jurisdiction before billing.

Commercial payers largely mirror Medicare’s physician-order requirement, though some add prior authorization for audiology services above a certain frequency. Check individual payer policies before scheduling diagnostic audiometry.

Modifiers for CPT code 92552

Modifier misuse is a consistent audit trigger on audiology claims. The table below covers the modifiers most relevant to 92552 billing, when each applies, and where coders most commonly go wrong.

Top denial reasons for CPT 92552 claims and how to prevent them

Audiology denials cluster around a predictable set of errors. Fixing each one below before submission prevents most of the rejections billing teams see on CPT code 92552 claims.

Pabau, the practice management platform we build, integrates with the Claim.MD clearinghouse to catch several of these flags before claims reach the payer. When one does slip through, our guide to medical billing denial codes explains the CARC and RARC codes that come back.

• Missing physician order (Medicare): No signed referral or physician order in the chart. Prevention: Build a workflow that holds 92552 claims until the order is scanned and attached to the encounter.
• Wrong ICD-10 code: Screening code (Z01.10) used for a diagnostic encounter, or a diagnosis not on the payer’s LCD. Prevention: Maintain a payer-specific approved ICD-10 list and review it quarterly as LCDs are updated.
• 92552 billed with 92557: The most straightforward unbundling denial. Prevention: An automated denial management rule at claim entry that flags the 92552/92557 pairing before submission.
• Incorrect place of service: POS 11 (office) submitted when the service was delivered in a hospital outpatient setting. Prevention: Confirm POS during charge capture, not at billing.
• Lack of medical necessity documentation: Chart note does not connect the patient’s symptom to the need for diagnostic audiometry. Prevention: Use a clean claim checklist that requires a documented clinical indication in the encounter note before the claim is finalized.
• Modifier -59 applied to override the 92557 edit: This edit cannot be overridden by modifier. The claim is denied regardless. Prevention: Train billing staff that the 92552/92557 NCCI edit has no modifier indicator and cannot be unbundled.

Documentation best practices for 92552 compliance

Post-payment reviewers pull the chart behind each 92552 claim and check it against a fixed standard. The checklist below reflects what they verify, drawn from CMS LCD criteria and ASHA’s audiology reimbursement guidance.

• Audiogram in the chart: The audiogram printout must show thresholds (in dB HL) at each test frequency for each ear tested. A summary note without the audiogram is not sufficient for most payers.
• Clinical indication documented: The chart note must state the reason for the test (symptom, diagnosis, or clinical change). “Ordered by physician” alone does not establish medical necessity.
• Physician order on file: For Medicare, a signed, dated physician order must be present before the service date. The order must specify the test requested. A blanket referral for “audiology evaluation” is acceptable only if it can reasonably be interpreted to include diagnostic audiometry.
• Provider credentials documented: The interpreting provider’s name, NPI, and credentials must appear on the audiogram and in the chart note.
• Equipment calibration current: Audiometric equipment must be calibrated per ANSI standards. Calibration dates may be requested during a Medicare audit.
• Interpretation note: The audiologist’s or physician’s signed interpretation of results must appear in the medical record, separate from the audiogram data.

Building these checks into charge capture stops most documentation denials before the claim leaves the practice. Error-catching claims management software can hold a 92552 claim until the order and audiogram are attached.

For practices generating superbills, the superbill must include the physician order date, the ICD-10 code, and the rendering provider’s NPI to support clean claim submission.

How Pabau catches 92552 billing errors before submission

Without a pre-submission check, 92552 errors surface as denials. Someone then pulls the chart, finds the missing order or the 92557 conflict, and resubmits weeks later.

Pabau’s claims management software moves those checks to charge entry. It flags the 92552/92557 bundling conflict, checks for a physician order, and validates the ICD-10 pairing before the claim goes out. Clean claims then travel to the payer through the Claim.MD clearinghouse integration.

Your billing team spends less time reworking returned audiology claims, so payment for each hearing test arrives on the first submission.

Reduce audiology claim denials before they reach the payer

Pabau’s claims management software validates CPT code 92552 claims against bundling rules, physician-order flags, and ICD-10 pairings before submission. It catches the errors that generate denials.

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Conclusion

CPT code 92552 has a narrow scope. Its bundling risk with 92557 and Medicare’s physician-order rule still make it one of the more denial-prone audiology codes. Getting it right starts at the point of care: The audiogram, the clinical indication, the signed order, and the correct ICD-10 pairing.

If your team bills 92552 regularly, run the quarterly audit above and fix whichever check fails most often. A few extra minutes at charge entry cost far less than weeks of rework on a denied claim.

Book a demo to see how Pabau flags the 92552/92557 conflict and missing physician orders before your audiology claims go out.

Continue your research

Need to understand how claims are submitted electronically? 837 file format explains how electronic claim files are structured and what payers receive.

Want to reduce rework on returned claims? Electronic remittance advice covers how ERAs work and how to read denial reason codes efficiently.

Looking for a breakdown of denial reason codes? Denial codes in medical billing covers CARC and RARC codes and how to respond to each.

Building a compliance routine for your billing team? Medical billing compliance sets out the standards payers audit against.

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