This guide aims to provide coding, billing, and coverage guidance for vestibular evaluation procedures.
Clinicians are strongly encouraged to reference payer-specific policies when determining appropriate code reporting and documentation requirements for vestibular testing. Further, Medicare local coverage determinations and other payer policies will address which ICD codes support medical necessity and subsequent reimbursement for services. It is advisable to review payer guidelines and policies prior to billing.
Relevant Procedure Codes
The following Level I HCPCS CPT codes are available for reporting vestibular and related balance assessments.
Videonystagmography / Electronystagmography
| CPT Code | Description |
| 92540 | Basic Vestibular Evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording *(CPT Manual Instructions: Do not report in conjunction with electro-oculography [92270], spontaneous nystagmus test [92541], positional nystagmus test [92542], optokinetic nystagmus test [92544], or oscillating tracking test [92545].) |
| 92541 | Spontaneous nystagmus test including gaze and fixation nystagmus, with recording *(CPT Manual Instructions: Do not report in conjunction with electro-oculography [92270], basic vestibular evaluation [92540], or the set of positional nystagmus test [92542], optokinetic nystagmus test [92544], and oscillating tracking test [92545].) |
| 92542 | Positional nystagmus test, minimum of four positions, with recording *(CPT Manual Instructions: Do not report in conjunction with electro-oculography [92270], basic vestibular evaluation [92540] or the set of spontaneous nystagmus test [92541], optokinetic nystagmus test [92544], and oscillating tracking test [92545].) |
| 92544 | Optokinetic nystagmus test, bidirectional foveal or peripheral stimulation, with recording; *(CPT Manual Instructions: Do not report in conjunction with electro-oculography [92270], basic vestibular evaluation [92540] or the set of spontaneous nystagmus test [92541], positional nystagmus test [92542], or oscillating tracking test [92545].) |
| 92545 | Oscillating tracking test, with recording *(CPT Manual Instructions: Do not report in conjunction with electro-oculography [92270], basic vestibular evaluation [92540] or the set of spontaneous nystagmus test [92541], positional nystagmus test [92542], and optokinetic nystagmus test [92544].) |
| 92547 | Use of vertical electrodes *(CPT Manual Instructions: Add on code. Do not report in conjunction with electro-oculography [92270], or unlisted otorhinolaryngologic procedure [92700]. List separately and code associated primary procedure first [e.g., 92540, 92541, 92542, 92543, 92544, 92545, 92546].) Typical use is for when actual electrodes are used (e.g., ENG). |
Caloric Testing
| CPT Code | Description |
| 92537 | Caloric vestibular test with recording, bilateral; bithermal *(CPT Manual Instructions: Do not report in conjunction with electro-oculography [92270], or monothermal caloric testing [92538]. Code also Modifier 52 if only three irrigations are performed.) |
| 92538 | Caloric vestibular test with recording, bilateral; monothermal *(CPT Manual Instructions: Do not report in conjunction with electro-oculography [92270], or bithermal caloric testing [92537]. Code also Modifier 52 if only one irrigation is performed.) |
Computerized Dynamic Posturography
| CPT Code | Description |
| 92548 | Computerized dynamic posturography sensory organization test (CDP-SOT), six conditions (eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report. *(CPT Manual Instructions: Do not report in conjunction with electro-oculography [92270], or CDP SOT, ADT, and MCT [92549].) |
| 92549 | Computerized dynamic posturography sensory organization test (CDP- SOT), six conditions (eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report; with motor control test (MCT) and adaptation test (ADT). *(CPT Manual Instructions: Do not report in conjunction with electro-oculography [92270], or CDP SOT [92548].) |
Vestibular Evoked Myogenic Potential (VEMP) Testing
| CPT Code | Description |
| 92517 | Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP) *(CPT Manual Instructions: Do not report in conjunction with electro-oculography [92270], or other VEMP testing codes [92518 and 92519].) |
| 92518 | Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; ocular (oVEMP) *(CPT Manual Instructions: Do not report in conjunction with electro-oculography [92270], or other VEMP testing codes [92517 and 92519].) |
| 92519 | Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP) and ocular (oVEMP) *(CPT Manual Instructions: Do not report in conjunction with electro-oculography [92270], or other VEMP testing codes [92517 and 92518].) |
Rotational Testing
| CPT Code | Description |
| 92546 | Sinusoidal vertical axis rotational testing *(CPT Manual Instructions: Do not report in conjunction with electro-oculography [92270].) |
Electrocochleography
| CPT Code | Description |
| 92484 | Electrocochleography, with interpretation and report |
Medicare Coverage Policies for Vestibular Assessment and Treatment
Medicare provides coverage for vestibular assessment and evaluation when medically necessary, but does not cover treatment or management options for vestibular or balance-related issues when performed by audiologists. Most commonly, treatment or management options would include canalith repositioning procedures and vestibular rehabilitation therapy. These non-covered services should not be billed to Medicare when performed by audiologists. If claims need to be submitted for denial (e.g., for coordination with a secondary insurance plan) or if the patient requests that the claim be submitted to Medicare, the -GY modifier (Item or service statutorily excluded, does not meet the definition of any Medicare benefit) must be used with any codes for these non-covered services and/or devices. Additional information on Medicare coverage policies for audiologic procedures can be found here.
Frequently Asked Questions
- What component procedures are required when reporting 92540 (Basic Vestibular Evaluation) since it is a bundled code?
- How many positions are required to report 92542 (Positional nystagmus test) as part of the 92540 (Basic Vestibular Evaluation)?
- Since saccades (and by extension anti-saccades) are not included as part of the 92540 (Basic Vestibular Evaluation) code, how do I report those services?
- How do report incomplete ENG/VNG testing when not all of the bundled components were performed as part of 92540 (basic vestibular evaluation)?
- Can I report 92547 (use of vertical electrodes) when performing videonystagmography using infrared goggles?
- What code is most appropriate to report when performing a Dix-Hallpike procedure?
- What is the proper coding for an Epley/Semont procedure? Is this the same code for any canalith repositioning maneuver (e.g., barbeque roll, Yacovino maneuver, etc.)?
- What is the proper coding for caloric testing procedures?
- How do I report caloric testing when all testing conditions were not able to be obtained?
- What is the proper coding for computerized dynamic posturography testing procedures?
- Is this service typically covered and is any additional documentation required when performed?
- How do I report VEMPs when only performed on one ear?
- What rotational testing procedures are included in 92546 (sinusoidal vertical axis rotational testing)?
- Is there a minimum number of rotational testing frequencies or test conditions to report 92546?
- Are there insurance/payer minimum requirements for rotational chairs?
- Can I report 92546 (sinusoidal vertical axis rotational testing) for headshake testing?
- Should I report 92546 (sinusoidal vertical axis rotational testing) for VOR Suppression testing?
- How do I report vestibular assessment procedures that do not have a CPT code?
- Are there CPT codes that are available to report vestibular screening procedures?
Need more help?
Contact us at reimbursement@audiology.org.
CPT codes, descriptions, and other data are Copyright 1966, 1970, 1973, 1977, 1981, 1983–2024 American Medical Association. All rights reserved. CPT© is a registered trademark of the American Medical Association.
Disclaimer
The purpose of the information provided by the American Academy of Audiology Coding and Reimbursement Committee is strictly for educational guidance to audiologists. Action taken with respect to the information provided is an individual choice. The American Academy of Audiology hereby disclaims any responsibility for the consequences of any action(s) taken by any individual(s) as a result of using the information provided, and reader agrees not to take action against, or seek to hold, or hold liable, the American Academy of Audiology for the reader's use of the information provided. As used herein, the "American Academy of Audiology" shall be defined to include its directors, officers, employees, volunteers, members, and agents.
