Pediatric Coding Alert

Question: I have had two patients who have United Healthcare call to say that UHC has told them that 92587 was denied or applied to the deductible because it’s non-covered. They state that code is only used for infants/newborns. Looking in CPT 2013, I don’t see any age restrictions listed at all. Can you advise?

Illinois Subscriber

Answer: Unfortunately, UHC has one of the tougher policies on billing 92587 (Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report).

UHC will pay for this service until age four, and after that they have strict guidelines for its use. The insurer’s policy states, "In order to comply with newborn hearing screening requirements and to follow guidelines from the research regarding testing of children, OET screening will be allowed for members up to age 4. There is inadequate evidence that hearing screening with OAEs is superior to screening audiometry in improving health outcomes such as timely facilitation of speech, language, and communication skills in older children or adults."

To read the UHC policy on this topic, visit www.uhccommunityplan.com/assets/Otoacoustical-Emissions-Testing-(R7104).pdf.