CPT code 92558 – Evoked otoacoustic emissions screening

Key takeaways

CPT Code 92558 covers automated OAE screening with a qualitative pass or refer result, reported once per screening encounter.

Medicare Part B excludes routine hearing screening for adult beneficiaries, while newborn coverage follows Medicaid EPSDT and commercial preventive benefits.

NCCI edits make 92558 mutually exclusive with 92587 and 92588 on the same date, so only one OAE code is billed per encounter.

Pabau, the practice software we build, scrubs 92558 claims for missing or invalid details and checks eligibility through Claim.MD before the visit.

CPT Code 92558: Official descriptor and what the procedure covers

CPT Code 92558 describes “Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis.”

The American Medical Association maintains it in the audiologic function tests range (92550-92597).

The procedure captures a brief sound played into the ear canal. A functioning cochlea produces a low-level sound in return, picked up by a probe microphone. Equipment analyzes the response automatically and reports a pass or refer result for each ear. The test takes under five minutes per patient and needs no behavioral response. That is why it dominates universal newborn hearing screening programs.

What CPT 92558 includes and excludes

The code bundles probe placement, automated stimulus delivery, response capture, pass/refer analysis, and documentation for both ears into one billable unit. No separate interpretation or report code is billable on top of 92558.

What 92558 explicitly does not cover:

• Diagnostic OAE testing with interpretation and report (92587 or 92588)
• Pure-tone audiometry, tympanometry, or reflex threshold measurement
• Auditory brainstem response testing (reported with 92585 or 92586)
• Otoscopy or cerumen removal, even when performed the same day
• Unilateral-only testing without a modifier to indicate reduced services

Sometimes one ear cannot be tested because of canal obstruction, excess vernix (common in neonates), or equipment failure. The encounter still uses 92558, with modifier -52 appended to signal reduced services. Billing 92558 without -52 for a documented one-ear test is an accuracy issue that can trigger a payer audit.

Clinical indications: When is CPT 92558 medically necessary?

The Joint Committee on Infant Hearing (JCIH) Year 2019 Position Statement recommends screening every newborn for hearing loss before hospital discharge. That makes universal newborn hearing screening the standard of care, and it drives most 92558 billing volume.

Beyond the routine newborn screen, payers recognize 92558 for these additional indications:

• Neonatal risk-factor evaluation: Infants with NICU admission exceeding five days, craniofacial anomalies, family history of permanent childhood hearing loss, or in-utero infections (CMV, rubella, herpes)
• Re-screening after a refer result: When the initial screen returned a refer, a repeat OAE screen before diagnostic workup is appropriate in many payer policies
• Pediatric well-child visit screening: Some commercial plans cover OAE screening at specific well-child intervals under ACA preventive benefit rules
• Ototoxicity monitoring: Children receiving cisplatin or aminoglycoside therapy may qualify under medical necessity with appropriate ICD-10 linkage

Accurate ICD-10 coding is essential to establishing medical necessity. The most commonly accepted diagnosis codes for 92558 claims include:

Payer LCD requirements vary by MAC jurisdiction. Confirm accepted ICD-10 pairings with your MAC’s local coverage determination before submitting 92558 on non-newborn encounters. The ICD-10 codes above are widely accepted but not universally guaranteed across all payer policies.

CPT 92558 vs. 92587 vs. 92588: Which code to use?

All three codes cover OAE testing, but each describes a different procedure scope. Picking the wrong one can trigger a bundling denial or a payer audit.

If the instrument reports only pass or refer, with no frequency-specific data and no interpretation and report, the correct code is 92558. Once the record carries an interpretation and report, the code is 92587 or 92588, depending on the frequencies tested. Per ASHA, a DPOAE run of fewer than 12 frequencies is reported with 92587.

NCCI edits make 92558 and 92587 mutually exclusive on the same date of service. Billing both for one encounter, even with different ear designations, results in a denial. The diagram below walks the same rule in two questions.

CPT 92558 vs. ABR testing (92585/92586): Choosing the right neonatal hearing test

OAE screening (92558) and auditory brainstem response (ABR) testing are two distinct pathways for neonatal hearing assessment. Each has its own clinical indications, equipment, and billing rules.

JCIH 2019 recommends ABR-based screening for all NICU graduates, because OAE testing cannot detect auditory neuropathy spectrum disorder. That condition is more prevalent in this population. Hospitals screening NICU infants with 92558 alone face both a clinical risk and a coverage risk if the payer’s LCD reflects the JCIH recommendation.

Modifiers for CPT 92558

92558 is reported once per screening encounter and, by convention, covers both ears. When the encounter differs from that, a modifier describes the difference.

The -25 modifier belongs on the evaluation and management code, not on 92558 itself. A common charting error puts -25 on the procedure instead. The E/M then denies while the OAE code pays, leaving the more valuable service unpaid.

Medicare and Medicaid coverage for CPT Code 92558

Medicare Part B does not cover routine hearing screenings for adult beneficiaries. Section 1862(a)(7) of the Social Security Act excludes routine hearing exams. Chapter 16 of the Medicare Benefit Policy Manual lists them among the general exclusions. Chapter 15, §80.3 covers diagnostic audiology tests only when a physician orders them to guide treatment, not to fit hearing aids. An audiologist or ENT billing 92558 for an adult Medicare patient in an office should expect a non-covered-service denial.

Coverage for newborns and pediatric patients follows different pathways. Running insurance eligibility verification before the encounter heads off coverage denials on 92558.

• Inpatient newborn (POS 21): Often covered under the facility’s global DRG payment for the birth admission. The hospital may not separately bill 92558 for newborns included in the DRG, so confirm with your MAC.
• Medicaid EPSDT: Federal law requires every state Medicaid program to cover Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services for beneficiaries under 21. Hearing screening is part of EPSDT, so coverage of 92558 is mandatory. State billing rules for prior authorization, claim format, and fee schedule still vary.
• Medicaid managed care: Coverage rules mirror the state Medicaid plan in most cases but verify with the specific managed care organization.
• ACA commercial plans (non-grandfathered): The ACA requires coverage of USPSTF Grade B recommended preventive services at no cost-sharing. Newborn hearing screening carries a USPSTF Grade B recommendation, meaning most commercial plans cover 92558 for newborns without cost-sharing when billed as a preventive service. This benefit does not apply to grandfathered health plans.

Private payer reimbursement for CPT Code 92558

Reimbursement rates for CPT Code 92558 vary by payer contract and geographic area. The CMS Physician Fee Schedule lookup tool provides the Medicare-based benchmark rate by locality, which commercial payers often use as a starting reference. Because 92558 carries a low relative value unit (RVU) weight appropriate for its brief automated nature, the absolute reimbursement per claim is modest.

Key reimbursement considerations for commercial payers:

• ACA preventive benefit: When billed for a covered newborn, the plan cannot apply cost-sharing (deductible, copay, coinsurance) on non-grandfathered plans. The claim should still be submitted with the correct ICD-10 screening code to route it to the preventive bucket.
• Prior authorization: Rarely required for routine newborn screening. Required more often for repeat screens or pediatric screens outside the well-child visit context. Confirm before the encounter for non-newborn indications.
• Fee schedule verification: OAE reimbursement may be bundled into well-child visit facility fees for some payers. If your contract specifies that preventive visit codes include ancillary screenings, 92558 may not be separately billable on those dates.

Pabau integrates with the Claim.MD clearinghouse, so practices can run real-time eligibility checks (270/271) before the patient arrives. That cuts down on same-day coverage surprises.

Documentation requirements to support CPT 92558

Documentation errors are a common cause of 92558 denials. The medical record must contain each of these elements to support a clean claim. Clean claim submission for OAE screening depends on capturing this information at the point of care, not reconstructing it later from memory.

• OAE equipment model, manufacturer, and most recent calibration date
• Screening protocol used: TEOAE (transient evoked) or DPOAE (distortion product) for the automated screening instrument
• Both ears tested, or documented reason for unilateral testing (canal obstruction, probe fit failure, patient agitation)
• Pass or refer result for each ear tested, as reported by the instrument
• Date and time of service
• Credentials of the performing provider (audiologist, physician, NP, or trained screener under appropriate supervision)
• Ordering provider name and NPI if different from the performing provider
• Signed ICD-10 diagnosis codes matching the clinical indication

For medical billing compliance, practices running high volumes of newborn screens should document the supervision framework in the medical record. This matters most when trained screeners who are not audiologists operate the equipment. Payer audits on 92558 frequently focus on provider credential documentation when the volume per provider is high relative to expected clinical capacity.

Common denial reasons for CPT 92558 and how to avoid them

Most 92558 denials trace back to a fixable step in the workflow. The table below maps frequent denial patterns to their root cause and the correction for each one.

For structured denial management workflows, review 92558 denial patterns monthly. A denial rate above 5% on a high-volume screening code like 92558 signals a systematic documentation or coding process issue. Use this guide to medical billing denial codes to match the CARC/RARC codes on each EOB to the root cause above.

Bundling rules: Can CPT 92558 be billed with other codes?

NCCI (National Correct Coding Initiative) edits govern which codes can be billed together on the same date of service. For 92558, the key bundling relationships are:

• 92558 with 92587 or 92588: Mutually exclusive. NCCI bundles all three OAE codes as an edit pair. Only one OAE code is billable per encounter per patient, regardless of which ears were tested or whether different equipment was used.
• 92558 with an E/M code (99202-99215, 99381-99395): Both are billable when the E/M service is significant and separately documented. Apply modifier -25 to the E/M code, not to 92558.
• 92558 with 92550 (tympanometry and reflex threshold): Generally bundled when both are performed the same day for the same indication. When the two are distinct and separately indicated, apply modifier -59 to the column-2 code in the current NCCI edit, not automatically to 92550.
• 92558 with 92585 or 92586 (ABR): Not bundled by NCCI. Both an OAE screen and ABR can be billed on the same date when clinically indicated, with appropriate documentation for each.

NCCI edits are updated quarterly. Confirm the pairings above against the current quarter’s edit tables before billing several audiology codes on one date.

Who can bill CPT 92558? Provider and setting requirements

Audiologists, physicians (including pediatricians and ENT surgeons), nurse practitioners, and physician assistants can bill CPT Code 92558. State scope-of-practice rules and payer credentialing still apply. Who may perform the test is a separate question. Many hospitals use trained non-licensed screeners to run the OAE equipment. The claim still goes out under a credentialed provider NPI, with the supervision relationship documented.

Provider type and setting considerations:

• Audiologists: Can bill 92558 independently under their own NPI in all states. Medicare Part B covers diagnostic audiology tests, not screening. Newborn screening usually routes through Medicaid or commercial payers, where audiologist billing is well supported.
• Physicians (MD/DO): May bill 92558 when performed in their office or as part of a hospital delivery service. Pediatricians performing office-based re-screens are the most common physician billing pattern.
• NPs and PAs: May bill 92558 under their own NPI in states where their scope of practice includes ordering and supervising auditory screening. Confirm state regulations before billing independently.
• Hospital-based screeners: NICU nurses or trained hearing screening technicians perform the test. The hospital bills under the facility’s NPI as part of the newborn admission or outpatient encounter.

Place-of-service codes that support 92558 billing:

• POS 21 (Inpatient hospital): Newborn screening performed in the hospital before discharge
• POS 22 (On-campus outpatient hospital): Hospital-based outpatient audiology
• POS 11 (Office): Pediatric or audiology office re-screen
• POS 19 (Off-campus outpatient hospital): Hospital-affiliated outpatient clinic

Facility and non-facility rates differ for 92558, so the same screen pays differently by setting. A grasp of medical billing fundamentals helps practices set realistic reimbursement expectations for each one.

How Pabau keeps 92558 screening claims clean

Practices that run newborn or well-child screens bill 92558 in volume, often keying the code, modifier, and diagnosis by hand after the visit. A missing -52 or a wrong place-of-service code then surfaces weeks later as a denial.

With Pabau’s claims software for audiologists, each claim is scrubbed for missing or invalid details before it goes out. Through the Claim.MD clearinghouse, the front desk runs a 270/271 eligibility check before the visit. The plan type and coverage status are known before the probe goes in.

The outcome is fewer resubmissions on a low-fee code, where every reworked claim eats into a modest payment.

Get 92558 claims paid on the first submission

Pabau’s claims management software scrubs each claim for missing or invalid details. It also checks eligibility through Claim.MD before the visit.

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Conclusion

Treat 92558 as a documentation decision before it is a billing one. If the record shows only an automated pass or refer, 92558 is the code. Once a clinician interprets frequency data, the claim belongs to 92587 or 92588.

Settle the payer’s rules before the screen rather than after the denial: eligibility, any preventive modifier, and the place of service. That order keeps a five-minute test from turning into weeks of appeals.

Pabau’s claims management software scrubs claims for missing or invalid details and, through Claim.MD, checks eligibility before the visit. Book a demo to see how Pabau handles audiology and pediatric billing from check-in to payment.

Continue your research

Need to understand how clearinghouse submission works? The Claim.MD clearinghouse guide covers how electronic claims move from practice management software to payer adjudication.

Seeing recurring denial patterns across your audiology claims? Revenue cycle management fundamentals explains how to build a denial tracking and appeals process that reduces write-offs systematically.

Want to submit cleaner 837P files? The 837 electronic claim file guide breaks down claim loop structures and the format errors that get audiology claims rejected at the clearinghouse.

Frequently asked questions