92540 Basic vestibular evaluation…
92541 Spontaneous nystagmus including gaze and nystagmus, with recording test, fixation
92542 Positional nystagmus test, minimum of 4 positions, with recording
92543 Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests), with recording
92544 Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording
92545 Oscillating tracking test, with recording
92546 Sinusoidal vertical axis rotational testing
92547 Use of vertical electrodes (List separately in addition to code for primary procedure)
Reimbursement Guidelines from UHC insurance
UnitedHealthcare Community Plan reimburses for audiologic/vestibular function testing (CPT codes 92537, 92538, 92540, 92541, 92542, 92544, 92545, 92546, 92547, 92550, 92553, 92555, 92556, 92557, 92561, 92562, 92563, 92564, 92565, 92567, 92568, 92570, 92571, 92572, 92575, 92576, 92577, 92582, 92583, 92584, 92585, 92597, 92620, 92621, 2625) when one of the diagnosis codes are listed on a claim denoting problems associated with either balance or hearing.
UnitedHealthcare Community Plan will not reimburse when the treatment rendered is without inclusion of one of the ICD9/ICD-10 diagnostic codes being included on the claim accurately reflecting the member’s condition.
Basic Vestibular Evaluation
The basic vestibular evaluation (92540) is a bundled code, defined as including 92541,92542, 92544, 92545 .
These procedural components must be included in their entirety, including a minimum of four positional tests. If all four of these procedural components are not
completed on a patient in a single encounter, it is inappropriate to use the bundled 92540 code. Instead, you report the individual codes for the procedures that were performed.
However, since the intent of the basic vestibular evaluation is bundled to include four components, when filing the claim for this evaluation a modifier must be added to indicate the procedure was not completed as intended.
In such a situation in which all four of the procedures of the vestibular evaluation were not completed, a modifier 59 would be added to each of the individual codes that were performed to indicate that they were separate and distinct diagnostic procedures to indicate a distinct procedural service. When using the modifier 59, make sure there is appropriate documentation in the report as to why the full basic vestibular evaluation was not performed. Always remember, it is inappropriate to unbundle the vestibular evaluation code for the sole purpose of higher reimbursement by billing the components separately
There is no specific CPT code for “Dix-Hallpike.” This maneuver is typically considered a positional component of 92542, positional nystagmus test, minimum of four positions. As noted earlier, CPT code 92542 is also included as part of the basic vestibular evaluation (92540). If performed in isolation, 92542 should be reported with the modifier 59 to indicate a distinct procedural service
Humana insurance billing Guide
CPT code 92540 (basic vestibular evaluation) includes all the services separately included in CPT codes 92541 (spontaneous nystagmus test), 92542 (positional nystagmus test), 92544 (optokinetic nystagmus test), and 92545 (oscillating tracking test). Therefore, none of the component test CPT codes (92541, 92542, 92544, and 92545) may be reported with CPT code 92540. Additionally, if all four component tests are performed, CPT code 92540 should be reported rather than the four separate individual CPT codes. If one, two, or three of the component tests are performed without the others, the individual test codes may be reported separately. However, if two or three component test codes are reported, NCCI-associated modifiers should be utilized
Billing and coding Guidelines
This bundled code is used to bill for codes 92545, 92542, 92544, and 92545 when they are performed on the same patient on the same date of service.
92543 is not included in this bundle and should still be billed separately with the appropriate number of units to reflect the number of irrigations performed.
Spontaneous nystagmus portion of the common ENG/VNG test protocol; if billed with either 92542, 92544 and/or 92545 (two or three of the 92540 codes) add ‐59 modifier.
Positional portion of the common ENG/VNG test protocol, including all positions and the Hallpike maneuver; if billed with either 92541, 92544 and/or 92545 (two or three of the 92540 codes) add ‐59 modifier.
Optokinetic portion of the common ENG/VNG test protocol; if billed with either 92541, 92542 and/or 92545 (two or three of the 92540 codes) add ‐59 modifier.
Tracking portion of the common ENG/VNG test protocol; if billed with either 92541, 92542 and/or 92544 (two or three of the 92540 codes) add ‐59 modifier.
Use 92547 in conjunction with codes 92541‐ 92546