Hearing Screening and Billing with Highmark Wholecare

Hearing loss is the most common congenital condition in the United States. The Joint Committee on Infant Hearing recommends universal newborn hearing screenings as well as periodic screenings throughout childhood to detect acquired hearing loss and congenital cases missed by inadequate or inaccurate newborn tests. However, even when these screenings are performed, not all children are rechecked or referred to treatment if needed.¹  

All newborns should receive an initial hearing screening before being discharged from the hospital as part of the universal newborn hearing screening. If the hearing screening was not completed in the hospital or was inconclusive, a hearing screening should be completed by 3 months of age.

Additionally, providers should conduct hearing screenings at the following ages:

• Age 4
• Age 5
• Age 6
• Age 8
• Age 10
• Between ages 11-14
• Between ages 15-17
• Between ages 18-20

The goal of a hearing screening is early detection of hearing loss to improve developmental and language outcomes. Hearing impairment in childhood has a detrimental impact on effective communication, development, and educational performance.

Billing

All Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) screening services must be reported with the age-appropriate evaluation and management code along with the EP modifier.

• 12 month to 4 year EPSDT visit CPT Code is 99382 or 99392
• 5 year to 11 year EPSDT visit CPT Code is 99383 or 99393
• 12 year to 17 year EPSDT visit CPT Code is 99384 to 99394

Providers should choose the most appropriate test:

• The CPT code for Audio Screen is 92551
  • Screening Test, pure tone, air only. This is effectively a pass or fail test. If the patient fails, they should be scheduled for the Threshold test or referred to an audiologist to determine the problem.
• The CPT code for Pure tone-air only is 92552
  • The Threshold test is used to define more specific diagnosis of the patient’s hearing problem. This test identifies the softest level a patient can hear.
• The CPT code for Tympanometry is 92567
  • This tests how well the eardrum moves.
• The CPT for Acoustic reflex testing, threshold is 92568
  • During this test, sounds move through a device in the ear to measure a reflex.

¹ Hearing Screening at Well-Child Visits

For questions regarding the EPSDT program, please contact EPSDTinfo@HighmarkWholecare.com.

These codes are not all encompassing and use does not guarantee payment. They are intended as a guide to provide education around appropriate screenings and coding as part of the EPSDT program.