92586/7 (Hearing Screen) and UHC – Clarification

I don’t think this is archived on the AAP WWW site, yet, but the Private Payor Advocacy group just released the following:

1. Clarification on UnitedHealthcare (UHC) audiological and vestibular function testing policy

As reported in its September Network Bulletin, UHC is dropping CPT code 92587 (Evoked otoacoustic emissions; limited (single stimulus level, either transient or distortion products)and previously had dropped CPT code 92586 (Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system, limited) from this policy. Removing the codes from the review means that the claims for newborn hearing screening will be paid with either of those two CPT codes (92586 and 92587). Claims for these two codes will not be denied payment subject to the UHC policy. The policy lists certain CPT codes that will be paid if they are linked with certain diagnoses. However, CPT codes 92586 and 92587 are removed from the UHC policy meaning that for purposes of claims payment, they do not need to be linked to the certain diagnostic codes listed in the in UHC policy. The AAP coordinated pediatric input to UHC to revise this policy and UHC made the change given the prevalent use for screening purposes in the pediatric population.

The important part reads:

…claims for newborn hearing screening will be paid with either of those two CPT codes (92586 and 92587)…they do not need to be linked to the certain diagnostic codes listed in the in UHC policy.

Good news! And good work, PPAC!

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