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Thread: Cerumen Removal/CMS Regs

  1. #1

    Default Cerumen Removal/CMS Regs

    AAPC: Back to School
    Can anyone point me in the direction of CMS guideance on cerumen removal? I have CPT Assistant from July 2005 that addresses this, but I am needing Medicare regs as well, please. I have gone to the CMS website with no luck. Thanks.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  2. #2
    Join Date
    Apr 2007
    North Carolina


    My carrier has a policy on this......

    Modifier 25 and Ear Lavage

    Q: Can an established patient visit and ear lavage be paid the same dos?

    A: Ear lavage to remove ear wax would be considered part of an evaluation and management visit. Ear lavage may be done by either the physician or his/her staff. If a patient had impacted cerumen removed by the physician (e.g. via curettes) then CPT code 69210 could be billed. (Removing wax that is not impacted does not warrant the reporting of CPT code 69210)

    As far as billing an E&M visit in addition to removal of impacted cerumen, visits by the same physician on the same day as a minor surgery or endoscopy are included in the payment for the procedure, unless a significant, separately identifiable service is also performed. For example, a visit on the same day could be properly billed in addition to irrigating the ears if, for example, a neurological assessment was medically necessary — i.e. done because the patient exhibited symptoms beyond those attributable to impacted cerumen: but, billing for a visit would not be appropriate if the physician only identified the need to remove the impacted cerumen. (See CMS Publication 100-4, the Claims Processing Manual, Chapter 12, section 40.1, subsection C via the attached link:

  3. #3


    Thanks this is actually what I was looking for.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  4. #4
    Join Date
    Apr 2007
    North Carolina



    For some reason, I didn't notice your location before. Looks like Cigna Government Services is also your MAC. See Question #2...


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