Does Cigna Cover cerumen removal?

Health insurer Cigna recently announced that, starting Nov. 14, it will deny office visit evaluation and management (E/M) services as not separately payable when billed with the removal of impacted cerumen if the removal is the sole reason for the visit.

Does CPT 69210 need a modifier?

A: The coder would report CPT code 69210 (removal impacted cerumen requiring instrumentation, unilateral) with modifier -50 (bilateral procedure) twice. Alternatively, the coder could report code 69210 twice with modifiers -LT (left side) and -RT (right side).

Can 69210 be billed alone?

This means that for Medicare payers, the relative value units assigned to 69210 “are already based on the procedure being performed as a bilateral procedure.” In contrast to CPT® instructions, the Centers for Medicare & Medicaid Services (CMS) allows only one unit of 69210 to be billed when furnished bilaterally.

What procedure code is 69210?

Code 69210 is defined as “removal impacted cerumen (separate procedure), one or both ears.” Use this same code only once to indicate that the procedure was performed, whether it involved removal of impacted cerumen from one or both ears.

Can modifier 50 be used with 69210?

For bilateral impacted cerumen removal, report code 69210 with modifier 50, Bilateral Procedure, appended.

How do you bill for cerumen removal?

Removal of impacted cerumen is represented by the following two CPT codes:

  1. 69209 – Removal impacted cerumen using irrigation/lavage, unilateral.
  2. 69210 – Removal impacted cerumen requiring instrumentation, unilateral.

Is 69210 covered by Medicare?

Medicare cannot reimburse audiologists for CPT code 69210 or HCPCS code G0268 under any circumstances.

Can you bill for cerumen removal?

Removal of impacted cerumen is represented by the following two CPT codes: 69209 – Removal impacted cerumen using irrigation/lavage, unilateral. 69210 – Removal impacted cerumen requiring instrumentation, unilateral.

Does Medicare cover 69210?

Does Medicare pay 69210?

How Much Does Medicare pay for 69210?

$33.88

CPT Code 69210 Removal impacted cerumen (separate procedure), 1 or both ears
Facility
Average Medicare Reimbursement Per Procedure** $33.88
Break Even (Procedures) 3.33
TOTAL RETURN ON INVESTMENT $727.50

Is there a bilateral code for 69210?