Cerumen Removal being bundled with Audiogram Same day

[crosa]

I have carriers rejecting cerumen removal (69210) when audiogram is billed the same day. Does anyone have any suggestions on how to have my claims considered. The carriers continuously keep bundling this procedure.

 

[terry4162]

You have to use the G0268 for cerumen removal by physician on same day as an audio.

 

[crosa]

Thanks Terry
Can the Gcode be used for all carriers of just Medicare?

 

[Sheri Varner]

Only MCR recongizes the CPT code G0268. However, most insurance companies will Not cover a Cerumen removal if performed the same day as a hearing test. Insurance sees this procedure as part of the hearing test (audio) performed... even if the patient is referred to see a physician for the Cerumen removal, insurance still considers this as a non-payable service.
Hope this helps.

Sheri Varner

 

[stellintx]

Actually, I have found that SOME insurance companies want you to use the
G0268 code also. I would try billing that and see what happens even if it is private insurance.

 

[Lisa Bledsoe]

Who is doing the audiogram and the cerumen impaction removal? If done by an audiologist, does "he/she" count as an approved provider for the cerumen impaction removal? I believe it has to be done by an MD/DO/PA/NP...please correct me if I'm wrong about that.

 

[crosa]

Cerumen Removal

Yes some PVT ins carriers accept the Gcode and pay it. Is it fraud to use it to get away with the unbundling issue.