We’re making some updates to our Audiology Payment Policy and associated billing and reimbursement practices, effective for dates of service beginning June 1, 2025.
As noted in this article also in this issue of Insights and Updates for Providers, we’ve developed an integrated Point32Health Payment Policy for Audiology, which is replacing the previous plan-specific Harvard Pilgrim and Tufts Health Plan Audiology Payment Policies. The following claim edits on the policy, which currently apply for Tufts Health Plan products, will be applied to Harvard Pilgrim Commercial plans as of June 1:
Acoustic reflex testing
CPT codes 92568 or 92570 (acoustic reflex testing) are compensated no more than once within six months (180 days) unless the diagnosis is one of the following:
- Benign neoplasm of brain/nervous system
- Conversion disorder
- Disease of the ear and mastoid process
- Encounter for antineoplastic chemotherapy
- Long-term use of antibiotics
- Multiple sclerosis
- Poisoning by other specified antibiotics
Maximum unit limitations
- 92557 or 0212T (comprehensive audiometry threshold evaluation and speech recognition) are reimbursed only once per year unless billed with a requisite diagnosis.
- 92567 (tympanometry) is reimbursed only twice per year unless billed with a requisite diagnosis.
(Consistent with Maine regulations, a redlined version of this policy is posted temporarily.)