CPT code 92555 – Speech recognition threshold audiometry

Key takeaways

CPT code 92555 covers speech recognition threshold (SRT) testing only. Adding word recognition scoring turns the claim into 92556.

92555 is never billed on the same date as 92556 or 92557, because both codes already include the threshold.

Medicare covers 92555 as a diagnostic test with a physician order, or under audiologist direct access with modifier AB once every 12 months.

Routine hearing exams are excluded from Medicare under Section 1862(a)(7) of the Social Security Act.

A missing order and a same-day bundling edit are the two leading denial triggers on 92555 claims.

Pabau’s claims management software checks eligibility and submits audiology claims through the Claim.MD clearinghouse.

CPT code 92555: Official descriptor and procedure details

CPT code 92555 is the procedure code for speech audiometry threshold testing. ASHA’s Medicare coding rules give its descriptor as Speech audiometry threshold, and the code finds the speech recognition threshold (SRT).

That is the softest level at which a patient correctly repeats 50% of spondaic words. Spondees are two-syllable words with equal stress, such as “baseball” or “hotdog.”

The SRT result is recorded as a decibel (dB HL) value per ear. It cross-checks the pure-tone average from separate testing (92553), which is its own billable procedure.

It also sets the presentation level for word recognition testing. When word recognition runs in the same session, the claim line becomes 92556, which already includes the threshold.

CPT 92555 vs 92553 vs 92556 vs 92557: Key differences

These four adjacent audiology codes confuse coders most when they appear on the same date of service. Each describes a different test package. Both 92556 and 92557 contain the speech threshold, so 92555 can never sit beside either one on a claim.

The decision comes down to which tests appear on the audiogram for that date. The table below maps each combination to the claim line it produces.

Use AAPC Codify to verify the current NCCI column indicators before submitting claims that combine audiology codes. CCI edits update quarterly, and the column status can change.

Documentation requirements for CPT code 92555

Absent or incomplete documentation is the most common reason 92555 claims are denied on audit. Every element below must appear in the medical record before the claim is submitted. Submitting a clean claim starts with complete documentation, not claim formatting.

• Physician order or direct access: A dated, signed order from the referring physician or NPP stating the clinical indication. Medicare waives the order once every 12 months when an audiologist bills the test under direct access with modifier AB. Most commercial payers still want an order.
• Clinical indication: The diagnosis driving the test (e.g., documented sensorineural hearing loss, tinnitus, aural fullness). A screening order alone is insufficient for Medicare medical necessity.
• SRT results per ear: The threshold in dB HL recorded for each ear tested. If only one ear was tested, document why and append Modifier 52.
• Laterality: Explicitly state right ear, left ear, or bilateral in the report.
• Test conditions: Equipment used (calibrated audiometer), environment (sound-treated booth), and word lists administered.
• Provider credential: The supervising or performing audiologist’s name, credential (Au.D., CCC-A), and NPI.
• Date of service: Must match the claim form exactly.

MAC Local Coverage Determinations (LCDs) add jurisdiction-specific requirements. Noridian, CGS, Palmetto, and other MACs publish their own audiology LCDs. Always check your MAC’s current LCD before billing, because requirements vary by region.

Medicare coverage and CPT code 92555 reimbursement

Medicare Part B covers CPT code 92555 when a physician or NPP orders the test to evaluate a specific medical condition. Under CMS’s audiology direct access rule, an audiologist can also bill it without an order, with modifier AB, once every 12 months.

Routine hearing exams are excluded under Social Security Act Section 1862(a)(7), so the diagnostic-versus-routine distinction decides most coverage questions.

Always verify the current rate using the CMS Physician Fee Schedule lookup tool. Rates change each January and vary by MAC locality. Publishing a specific dollar figure without citing the current year and locality creates compliance risk.

Prior authorization requirements for CPT 92555

Medicare generally does not require prior authorization for CPT 92555 when the test evaluates a documented medical condition. Commercial plans are a different matter.

• Medicare Part B: No prior auth required for diagnostic audiometry. The physician order, or a direct-access visit billed with modifier AB, carries the medical necessity.
• Medicare Advantage plans: Requirements vary by plan. Check each plan’s prior auth list annually, because many MA plans require authorization for audiology services.
• Commercial insurers: Prior auth requirements differ by payer and plan year. Verify through the payer portal or by calling the provider line before the appointment.
• Medicaid: State-specific. Some state Medicaid programs require prior auth for audiology services; others do not.

Running insurance eligibility verification at the time of scheduling surfaces prior auth requirements before the patient arrives. A PA denial after the test is far harder to overturn than a PA request submitted beforehand.

Modifiers for CPT code 92555

Four modifiers come up on 92555 claims, and one of them is often applied where it should not be. Using the wrong one, or omitting a required one, is a consistent denial trigger.

Confirm your MAC’s specific modifier guidance. Some MACs publish audiology billing articles that clarify when Modifier 52 is required versus when documentation alone suffices for a unilateral test.

Common claim denial reasons for CPT 92555

Most 92555 denials fall into five categories, and each one has a clear corrective action. Structured denial management workflows catch these before they reach secondary review.

See our guide to denial codes for the CARC and RARC codes that accompany these rejections on EOBs.

NCCI bundling edits and coding conflicts for CPT 92555

The National Correct Coding Initiative (NCCI) sets the bundling relationships between 92555 and its neighbors. Under current CCI edits, 92555 is a column-two component of both 92556 and 92557. Each of those codes already pays for SRT testing, so billing 92555 beside either one duplicates the service.

Key NCCI rules for the audiology code family:

• 92555 + 92557 same date: Unbundling edit applies. Bill 92557 only. Modifier 59 cannot override this edit because the services are not distinct.
• 92555 + 92556 same date: Unbundling edit applies. 92556 is the threshold with speech recognition, so bill 92556 alone. No modifier bypasses this edit.
• 92555 + 92553 same date: Acceptable. Pure-tone audiometry and speech threshold testing are different test modalities with no CCI edit between them.
• 92555 alone: Appropriate when only SRT testing was performed, and neither word recognition nor comprehensive audiometry was billed.

CCI edits are updated quarterly. ASHA’s CCI edit tables list the audiology pairs and whether a modifier can bypass each one. Verify the current column indicators against the CMS NCCI edits page and the NCCI Policy Manual before each billing cycle.

How to bill CPT code 92555: Step-by-step

A complete 92555 billing workflow runs in seven steps. Medical billing fundamentals apply throughout, while audiology-specific rules govern steps one, four, and five.

1. Confirm the order or direct access. Check that a signed, dated order with a specific clinical indication exists before the patient is tested. Without one, Medicare pays only a direct-access visit billed with modifier AB.
2. Run an eligibility check. Confirm the patient’s coverage, deductible status, and whether prior authorization is required. Medicare Advantage plans in particular vary by contract.
3. Perform and document the SRT test. Record threshold levels in dB HL for each ear tested, the word lists used, the audiometer calibration date, and the test environment (sound booth).
4. Select the correct CPT code. Bill 92555 alone if only SRT was performed. Bill 92556 instead if word recognition was also performed. Bill 92557 if pure-tone air and bone, SRT, and word recognition were all performed on the same visit.
5. Apply modifiers. Append Modifier 52 if only one ear was tested, and modifier AB for a Medicare direct-access visit. Do not append Modifier 50.
6. Select diagnosis codes. Use the most specific ICD-10 code supported by documentation, usually H90.x (conductive or sensorineural hearing loss) or H91.x (other hearing loss). Avoid Z01.10 as the sole diagnosis for Medicare claims.
7. Submit through a clearinghouse. Pabau, the practice management platform we build, sends claims through the Claim.MD clearinghouse. Claim.MD runs real-time eligibility against 400+ US payers and routes 837P claims electronically. ERAs return as 835 remittances into the billing workflow.

ICD-10 diagnosis codes used with CPT 92555

The diagnosis code paired with CPT code 92555 must support medical necessity. For Medicare, a screening encounter code alone (Z01.10) is typically insufficient without a documented pathology.

Sometimes a visit documents both a screening encounter and a pathology. List the specific pathology code (H90.x, H91.x) as the primary diagnosis, so it anchors medical necessity.

How Pabau keeps 92555 claims matched to the audiogram

In many audiology practices, the order, the audiogram, and the claim live in three different places. The coder sees a claim line, not the test sheet. So a 92555 that should have been a 92556 goes out unchanged, and a missing order surfaces only when the denial arrives.

Pabau’s claims management software keeps the referral, the test results, and the claim on the same patient record. Eligibility checks run before the visit, so a Medicare Advantage plan that wants prior authorization shows up before the patient sits in the booth.

Claims go out through Claim.MD, and remittances post back against the same record. A denial for a missing order or a bundling edit then shows up as a claim status your billing team can work. It no longer waits for month-end reconciliation.

Reduce audiology claim denials with Pabau

Pabau checks eligibility before the visit, submits claims through the Claim.MD clearinghouse, and posts remittances against the patient record. See it working for an audiology or ENT practice.

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Conclusion

92555 is one of the simplest audiology codes to bill, as long as the claim matches the test. Word recognition in the same session makes the claim line 92556. Add pure-tone air and bone testing and it becomes 92557. Billing 92555 beside either one gets denied, and no modifier fixes it.

The order question is narrower than it used to be. A physician order still covers most Medicare visits, but an audiologist can see a patient once a year without one, under modifier AB.

Check which route each visit took before you code it. Book a demo to see how Pabau keeps the order, the audiogram, and the claim on one patient record.

Continue your research

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Looking for the billing rules on a related audiology code? Medical billing compliance guidance outlines documentation standards, payer audit triggers, and corrective action steps for outpatient practices.

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