Does Medicare pay for bilateral cerumen removal?

If the provider removes impacted cerumen from both the right and left ears, you may report a bilateral procedure. In other words: Medicare won’t pay anything extra if you report cerumen removal bilaterally. Check with your individual payers to determine their policies.

CMS does allow us to bill a bilateral procedure for cerumen removal by lavage using 69209-50. Finally, note that some payers may stipulate “advanced practitioner skill” is necessary to report removal of impacted earwax (i.e., payers may require that a physician provide 69209, 69210).

Also, how do you bill 69209 bilateral? Only one method of removal of impacted cerumen (i.e., either 69209 or 69210) may be reported when both are performed on the same day on the same ear. Procedure code 69209 is unilateral. If performed bilaterally, report 69209 on a single claim detail line with the modifier 50 appended.

Also asked, does Medicare pay for cerumen removal?

Medicare only covers procedures deemed to be medically necessary. Ear wax removal does not usually fall into that category. They include the same Part A and Part B coverage as Original Medicare, but many MA plans may provide additional coverage, such as hearing, vision, or dental care.

Does 69210 require a modifier?

When you are using 69210 for ear wax impaction, it is appropriate to use an E/M code (with modifier -25) if the patient received a true evaluation and management for a separate problem (such as bronchitis or pharyngitis) or for complicating problems (such as dizziness or otitis media).

How do you bill for cerumen removal?

Method Determines Coding for Impacted Cerumen Removal For removal by lavage, the correct code is 69209 Removal impacted cerumen using irrigation/lavage, unilateral. For removal using instrumentation (e.g., forceps, curette, etc.), turn instead to 69210 Removal impacted cerumen requiring instrumentation, unilateral.

How much does it cost to get your ears cleaned?

On MDsave, the cost of an Earwax Removal ranges from $90 to $231. Those on high deductible health plans or without insurance can shop, compare prices and save.

How do you bill bilateral procedures?

Bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate CPT or HCPCS code. The procedure should be billed on one line with modifier 50 and one unit with the full charge for both procedures.

Is 69210 a bilateral code?

CPT® identifies 69210 as a unilateral procedure. If the provider removes impacted cerumen from both the right and left ears, you may report a bilateral procedure.

What is earwax made of?

Earwax consists of dead skin cells, hair, and the secretions of cerumen by the ceruminous and sebaceous glands of the outer ear canal. Major components of earwax are long chain fatty acids, both saturated and unsaturated, alcohols, squalene, and cholesterol.

How do you bill 69210 for both ears?

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).

How does an ENT remove ear wax?

Your ENT can remove the earwax buildup or impacted earwax in the office. They will irrigate your ear canal with special substances made to soften and dissolve earwax. Then they will gently irrigate the ear canal to remove the earwax. It is a simple procedure, but you should not attempt it at home.

How do you bill for ear irrigation?

A new CPT code, 69209, provides a specific billing code for removal of impacted cerumen using irrigation/lavage. Like CPT 69210, (removal of impacted cerumen requiring instrumentation, unilateral) 69209 requires that a physician or qualified healthcare professional make the decision to irrigate/lavage.

Who should I go to for ear wax removal?

If it looks like you’re a candidate for professional removal, they’ll be able to help you or refer you to a doctor who can. Alternatively, your doctor might prescribe you wax softening drops. These are placed into the ear and allowed to drain out after a few minutes.

Does health insurance cover ear wax removal?

These are as simple as ear wax removal, and as substantial as cochlear implants. In most cases insurance will cover the cost of hearing tests. Sometimes insurance will cover treatments for hearing loss. Unfortunately, often private medical insurance does not cover hearing aids.

What is the ICD 10 code for cerumen impaction?

Impacted cerumen, unspecified ear H61. 20 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2020 edition of ICD-10-CM H61.

What is the 50 modifier?

Modifier 50 is used to report bilateral procedures that are performed during the same operative session by the same physician in either separate operative areas (e.g. hands, feet, legs, arms, ears), or one (same) operative area (e.g. nose, eyes, breasts).

Can a nurse remove impacted cerumen?

Does a physician have to remove cerumen to bill 69210 or 69209 or can a nurse remove it and still bill? 69209 can be done by the MA/Nurse as long as there is a cerumen impaction documented. this can be done by irrigation only.

How is impacted cerumen removed from the ear?

Earwax is produced by glands in the ear canal, which leads from the outer ear to the eardrum. Impacted cerumen should be removed by a doctor to help avoid damaging the ear. Treatment options include removing the earwax with instruments or by flushing the ear canal with special liquids.