Although contradictory to Current Procedural Terminology (CPT®) guidelines, many payers continue to deny or bundle vision (99173, screening test of visual acuity, quantitative, bilateral) and hearing (92551, screening test, pure tone, air only) screens when performed at the time of a preventive medicine visit.

CPT guidelines located under the “Preventive Medicine Services” heading in the “Evaluation and Management” section state

“Vaccine/toxoid products, immunization administrations, ancillary studies involving laboratory, radiology, other procedures, or screening tests (eg, vision, hearing, developmental) identified with a specific CPT code are reported separately.”

This statement clearly indicates that the listed services are not inherent to the preventive medicine visit (99381–99397). However, although payers are mandated to use the CPT as their official code set, many commercial payers and state Medicaid programs make their own payment policies and design their own claim edit systems based on those policies.

If...

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