If you run an audiology practice or an ENT (otolaryngology) office, you already know the punchline: the billing side of ear care is anything but simple. Both specialties share CPT code ranges, treat overlapping patient populations, and frequently work under the same roof. Yet the billing rules that govern each are strikingly different. Get those rules mixed up, and you’re looking at denied claims, costly audits, and delayed reimbursements.
“A 2024 review of 176 clinic encounters found that 60% of otolaryngology visits were inaccurately billed before billing feedback was implemented.”
The above statement staggering error rate that directly drains revenue. So, if you are an audiologist billing independently, an ENT physician employing in-house audiology staff, or a billing specialist managing both specialties, this guide gives you an authoritative, up-to-date walkthrough of every critical difference.
Audiology vs. ENT: Who Bills as What?
Before we proceed into medical coding, it’s essential to understand the provider classification that shapes every billing decision downstream.
Audiologists: Non-Physician Practitioners
Under Medicare, audiologists are classified as non-physician practitioners (NPPs). They hold a Doctor of Audiology (Au.D.) degree and are licensed to independently evaluate and manage hearing and balance disorders. Crucially, audiologists must bill Medicare under their own National Provider Identifier (NPI) and cannot bill under a supervising physician’s number.
ENT Physicians (Otolaryngologists): Physicians
ENT specialists are licensed physicians (MD or DO) with a surgical and medical scope of practice. They bill using Evaluation and Management (E/M) codes, procedure codes, and surgical codes across a broader range than audiologists. They may also employ audiologists or audiology technicians (oto-techs), which introduces a distinct set of supervision and split-billing rules.
Audiology Billing CPT Code Landscape
The CPT code range 92502–92700 (Special Otorhinolaryngologic Services) is shared between both specialties. That shared territory is where billing errors flourish. Understanding who can legitimately bill which codes, and under what circumstances, is the foundation of compliance.
Core Audiology CPT Codes
These codes are primarily billed by audiologists and represent diagnostic evaluation and hearing device services.
Diagnostic Hearing Evaluation
- 92552 – Pure tone, air only
- 92553 – Pure tone, air & bone
- 92557 – Comprehensive audiometry
- 92567 – Tympanometry
- 92570 – Acoustic immittance testing
- 92587 – OAE, limited
- 92588 – OAE, comprehensive
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Auditory Evoked Potentials (AEP)
- 92651 – Broadband stimuli, hearing status
- 92652 – Threshold estimation, multifrequency
- 92653 – Neurodiagnostic assessment
Cochlear Implant & Osseointegrated Device Services
- 92626 – Auditory function eval, pre/post CI, first hour
- 92627 – Each additional 15 min
- 92622 – AOI device programming, first 60 min
- 92623 – Each add’l 15 min
Core ENT/Otolaryngology CPT Codes
ENT physicians bill a much broader procedure set that spans E/M visits, surgical interventions, and shared diagnostic codes from the audiology range.
E/M & Office Visits
- 99202–99205 – New patient visits
- 99211–99215 – Established patient visits
Ear Procedures
- 69210 – Cerumen removal (instrumentation)
- 69433 – Tympanostomy, local anesthesia
- 69436 – Tympanostomy, general anesthesia
- 92504 – Ear microscopy
Nasal / Sinus Procedures
- 31231 – Nasal endoscopy, diagnostic
- 31237 – Nasal/sinus endoscopy with biopsy
- 30520 – Septoplasty
- 31295–31297 – Balloon sinuplasty
Laryngology & Head/Neck
- 31575 – Flexible laryngoscopy
- 60660 – Thyroid RFA, one lobe
- 60661 – Thyroid RFA, additional lobe
Codes Both Specialties Commonly Bill
- 92557 – Comprehensive audiometry
- 92567 – Tympanometry
- 92537–92546 – Vestibular testing
- 92548–92549 – Dynamic posturography
These shared codes are where billing conflicts most commonly arise, particularly around who performed the service, whether a technician was involved, and which modifier to append.
| Provider Type | Non-Physician Practitioner | Physician (MD/DO) |
| Primary CPT Range | 92550–92700, 92622–92653 | 99202–99215, 30000s–69999, shared 92xxx |
| E/M Code Usage | Limited; only diagnostic situations (NOT hearing aid visits) | Full E/M code access (99202–99215) |
| Surgical CPT Codes | Not applicable | Broad surgical scope (tympanostomy, sinuplasty, etc.) |
| Medicare Provider Status | Must bill under own NPI | Bills under physician NPI; can bill incident-to for certain services |
| Hearing Aid Billing | V-codes (HCPCS); Medicare excluded for traditional Part B | Not applicable |
| Technical Component (TC) | Generally not split (no TC/PC breakout for 92557) | Can bill TC with modifier TC when owning equipment |
Medicare Billing Rules of Audiology vs ENT
Audiology Under Medicare Part B
Medicare covers audiology services as diagnostic tests, not as independent professional services. This means audiologists do not need a physician referral to bill for non-acute hearing assessments unrelated to disequilibrium, hearing aids, or vestibular disorders when appending the AB modifier. This benefit may be used once every 12 months.
Hearing aids and related dispensing services are statutorily excluded from traditional Medicare Part B. However, Medicare Advantage (Part C) plans may elect to cover them using the new 2026 hearing device CPT codes
ENT Under Medicare
ENT physicians receive broader reimbursement access. For the 2025 Medicare Physician Fee Schedule (MPFS), CMS finalized a new add-on code G0559 for post-operative care provided by a practitioner other than the operating surgeon—valued at 0.16 RVUs—benefiting ENT practices providing post-surgical follow-up for patients not originally their own.
CMS also finalized updated pricing for percutaneous radiofrequency ablation of thyroid nodules with new codes 60660 and 60661 effective January 1, 2025.
The AB Modifier: Audiology’s Independent Billing Key
- The AB modifier allows audiologists to bill Medicare independently.
- Without a physician’s order, for non-acute hearing assessments unrelated to hearing aids or vestibular conditions.
- It is strictly limited to once every 12 months.
- Misuse of this modifier is a common compliance trigger during post-payment audits.
Modifiers That Make or Break Your Claim
Using the wrong modifier or omitting a required one is among the top denial triggers for both specialties.
| AB | Audiologist only | Independent audiology service without physician order; non-acute, not vestibular/hearing aid related; max once per 12 months |
| -26 | ENT Physician | Professional component only (interpretation/report) of a diagnostic test when technical work was done by an audiologist or facility |
| TC | ENT Physician / Facility | Technical component only; applicable when physician/group owns the equipment but audiologist performs interpretation |
| -59 | ENT (Surgical) | Distinct procedural service; essential for sinus surgeries involving multiple CPT codes to avoid NCCI bundling edits |
| LT / RT | Both | Laterality for vestibular and some device coding; some payers require even when codes are bilateral by default |
| -93 | Both (Telehealth) | Audio-only telehealth services under 2025 Medicare rules; no additional documentation beyond standard visit note required |
| G0559 | ENT Physician | New 2025 add-on code; post-operative follow-up by a different provider than the operating surgeon |
What Oto-Techs Can and Cannot Bill
This is one of the most misunderstood and audited areas in the ENT billing landscape. CMS policy, effective since September 30, 2010, is clear: audiology/oto-technicians cannot bill Medicare for CPT 92557 (comprehensive audiometry) because this code has no separate technical/professional component split. Only an audiologist, physician, or NPP may perform and bill for 92557.
Codes Oto-Techs May Perform (Technical Component Only, Under Direct Physician Supervision)
- 92537–92546 – Vestibular testing codes
- 92548–92549 – Dynamic posturography
- 92587–92588 – OAE codes
For these codes, the oto-tech performs the technical component under direct physician supervision. The ENT physician, audiologist, or NPP must provide and bill the professional component (interpretation and report).
Virtual Direct Supervision
For services furnished “incident to” a physician’s services and performed by auxiliary personnel, CMS in CY2025 permanently adopted a definition of direct supervision that allows virtual supervision via live video and audio telecommunication. This applies when the service has a PC/TC indicator of “5” or is billed under 99211.
2026 Regulatory Updates You Must Know
- 12New audiology CPT codes effective Jan 1, 2026 for hearing device services
- 2 New thyroid RFA codes (60660–60661) finalized for ENT
- G0559 New ENT add-on code for post-op care by non-operating surgeon
Audiology: Major 2026 Hearing Device Audiology Code
Effective January 1, 2026, the AMA CPT Editorial Panel approved 12 new CPT codes (92628–92637) to replace the longstanding hearing aid codes 92590–92595. These new codes cover candidacy determination, device selection, and hearing device services. Key billing rules for the new codes:
- Time-based codes (92628–92632) use the “half plus one” rule: a 30-minute code requires at least 16 minutes of service to bill one unit.
- Add-on codes apply only after the full time requirement for the base code is met.
- Codes 92634–92637 are billed unilaterally or bilaterally—billing is based on time spent, not laterality.
- These changes apply to CPT codes only; HCPCS V-codes for hearing aids remain unchanged.
- Traditional Medicare Part B continues to exclude hearing aid services; verify Medicare Advantage plans individually.
Top Billing Errors and How to Prevent Them
Here are a few billing errors that you could avoid to run a smooth billing system
Audiology-Specific Denial Triggers
- Billing 92557 when service was performed by an oto-tech or Hearing Instrument Specialist (HIS) is not billable, period
- Using the AB modifier more than once in a 12-month window
- Billing hearing aid services (V-codes) to traditional Medicare Part B without a Medicare Advantage benefit
- Using E/M codes for hearing aid follow-up visits, use 92592 (monaural check) or 92593 (binaural check) instead
- Billing audiologist services under a supervising physician’s NPI in an ENT or hospital setting
- Failing to update payer contracts when new CPT codes (e.g., 92622–92623 from 2024) have not been loaded by the payer
ENT-Specific Denial Triggers
- Submitting multiple sinus CPT codes without modifier -59, triggering NCCI bundling edits
- Vague documentation phrases like “follow-up” or “routine care” are insufficient to support medical necessity
- Mismatched CPT and ICD-10 code pairs leading to medical necessity denials
- Missing laterality documentation for nasal endoscopy (31231) when billed multiple times annually
- Assuming prior authorization approval equals payment, always submit a clean claim with full supporting documentation
- Failing to append the 26 modifier when an ENT provides only the professional component for a diagnostic test performed by the audiologist
Shared / Overlap Errors
- Billing 92626 and 92622 together, CPT parentheticals prohibit reporting these codes in conjunction with each other
- Failing to distinguish new vs. established patient status (new = no visit with the practice’s audiologist in the past 3 years)
- Not checking the Medicare Administrative Contractor (MAC) policies before billing vestibular codes performed by technicians. MACs have the authority to define technician qualifications for technical component billing
Conclusion
Audiology and ENT billing share more codes than most practitioners realize—and that shared space is where revenue leaks. The core distinctions come down to four pillars:
- Provider classification (NPP vs. physician)
- CPT code scope (diagnostic-focused vs. surgical + diagnostic)
- Medicare billing rules (own NPI vs. incident-to options)
- Technician supervision standards (strictly limited under both specialties)
With 12 new audiology CPT codes and tightening prior authorization requirements from commercial payers, staying current isn’t optional; it’s the difference between a healthy revenue cycle and a claims backlog that drains your practice. So, stop leaving revenue on the table and consult Connecticut Medical Billing. We specialize in audiology and ENT revenue cycle management, from CPT code accuracy and modifier compliance to denial management. Get your free billing audit today!
FAQs
Is audiology considered ENT?
No, Audiology and ENT (Otolaryngology) are not the same, though they both deal with ear, nose, and throat health;
What is the 60-60 rule in audiology?
The 60/60 rule for hearing is a guideline to prevent noise-induced hearing loss by limiting audio device use to 60% of maximum volume for no more than 60 minutes at a time, followed by a break
What is the key difference between an ENT and an audiology billing?
An audiologist employed by an ENT practice must still bill under their own NPI for diagnostic audiology services. Billing audiologist services under the physician’s NPI—even “incident to”—is a compliance risk that CMS and ASHA explicitly caution against.