Rhode Island Medicaid: OAE testing is not medically necessary for routine hearing screening

Claims submitted without an approved ICD-10 code will be denied

Reminder: Do not use otoacoustic emissions (OAE) testing for routine screening. CMS states OAE testing is medically necessary only for:

• Infants younger than 90 days for neonatal screening
• Infants and children younger than age 4
• Children and adults who are unable to cooperate with other methods of hearing tests (e.g., stroke patients or individuals with autism)

What this means for you

We will deny claims for routine hearing tests for members ages 4 and older. When submitting claims using CPT® codes 92558, 92587 and 92588, you must include an approved ICD-10 code from the Otoacoustic Emissions Testing ICD-10 Diagnosis Policy List.

Why this matters

Studies show OAE testing is inadequate for improving health outcomes for individuals and conditions outside of the populations identified by CMS. This includes auditory screening and diagnostic testing that use OAEs for ototoxic hearing changes in individuals treated with ototoxic medications.

For information on these studies, review the UnitedHealthcare Community Plan Reimbursement Policy for Otoacoustic Emissions Testing Policy, Professional.