Billing for CPT Code 69210 - Removal of Impacted Cerumen

Billing for CPT Code 69210 - Removal of Impacted Cerumen

Providers can bill and receive reimbursement for impacted cerumen removal with OtoSet® or other devices by using CPT code 69210. Please note that medicare and some insurance carriers do NOT cover lavage and require the removal of IMPACTED cerumen to bill for CPT 69210.

When billing CPT 69210, an auditor will be looking for these details in the progress notes:

  • List the Device Used.
    • Which device, instrument, curette, suction device or equipment was used in the removal of impacted earwax?
  • Include Magnification Language.
    • Was an otoscope used? Explain the means in which magnification was achieved.
  • The Word "Impacted" Must be Included.
    • A medicare auditor will always be looking for the word "impacted" when auditing CPT 69210.
 Reimbursement Code: Description: Facility/Non-Facility:
CPT 69210 Removal of impacted cerumen (separate procedure), one or both ears $33.66 (Facility) / $50.13 (Non-Facility)
  • If there was no cerumen impaction and only lavage, billing will fall under E&M (Evaluation & Management) visit code.

Facility & Non-Facility:

  • Facility: Includes hospitals (inpatient, outpatient, and emergency department), ambulatory surgery centers (ASCs), and skilled nursing facilities (SNFs).
  • Non-Facility: Includes all other settings

When should I use HCPCS II G0268 over CPT 69210?

The G0268 is an HCPCS II code for impacted Cerumen and has not been used as often since 2008 after medicare required audiologists to bill for their services separately from the physician. Please visit the website below to learn more on HCPCS G0268.

Please note: The information contained in this document is provided for convenience only and represents no statement, promise, or guarantee by SafKan Health concerning coverage or levels of reimbursement. Payment will vary by geographic locality. It is always the provider’s responsibility to determine accurate coding, coverage and claim information for the services that were provided. CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/ DFARS Restrictions apply to Government Use.

Fee Schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.