CPT

Cerumen Removal CPT 69210

In an update to our previous article on Cerumen Removal, we are providing updated information.

 

Beginning January 2014 AMA changed the code description of CPT Code 69210 from “1 or both ears” to “unilateral”.  However, the Centers for Medicare and Medicaid Services has indicated they will continue to only reimburse for 1 unit per day.
 
Specialty societies stated and AMA agreed, although there is no information to determine how often the service was performed unilaterally, the service was performed bilaterally 10 percent of the time. 
 
CMS disagree with the assumption that the procedure will be furnished in both ears only 10 percent of the time as the physiological processes that create cerumen impaction likely would affect both ears.  Given this, CMS is continuing to allow only one unit of CPT 69210 to be billed when furnished bilaterally.  CMS does not believe that AMA recommended value reflects this and therefore, they will maintain the CY 2013 work value (0.61) for CPT code 69210 when the service is furnished.
 
Our recommendation is to ensure when billing Cerumen Impaction Removal to use the appropriate modifiers (LT, RT or 50), even when billing Medicare.  The use of any of these modifiers with Medicare should not increase your payment as they will only reimburse for a single unit per day.  This is the only way to produce statistical data of how offend this procedure is performed unilaterally vs bilateral.
Federal Register/Volume 78, No. 237 / Tuesday, December 10, 2013/Rules and Regulations 74341(14) Cerumen Removal (69210) at http://www.gpo.gov/fdsys/pkg/FR-2013-12-10/html/2013-28696.htm.
 
Medically Unlikely Edits
Current Procedural Terminology© 2013 American Medical Association. All Rights Reserved.

Current Procedural Terminology (CPT) is copyright 2013 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

CPT® is a trademark of the American Medical Association.
HCPCS/CPT Code
Practitioner Services MUE Values
69210
1