Using G0268 for Cerumen Removal

Question:

When would I ever use G0268 for cerumen removal vs 69210?

Answer:

G0268 is a HCPCS II code for “Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing” while CPT code 69210 says “Removal impacted cerumen requiring instrumentation, unilateral.”  Historically, G0268 was used for the otolaryngologist’s work to remove impacted cerumen on the same patient as the audiologist performed diagnostic testing on the same day and all services were billed by the physician.  Using G0268 allowed payment for the procedure performed by a different provider because cerumen removal by an audiologist would be included in the diagnostic testing service.

Since 2008 when Medicare required audiologists to bill for their services separate from the physician, we’ve not had to use G0268 as often.  Most payors will separately credential audiologists (which we recommend doing, by the way) so they can bill separate from the physician; again, decreasing the need to use G0268.

So when would you use G0268?  When you, the physician, are submitting a claim for removal of impacted cerumen as well as the diagnostic testing performed by your audiologist on the same dayandthat payor “bundles” 69210 with the diagnostic testing.  You’d use G0268, instead of 69210, to show a different provider performed the cerumen impaction removal.

*This response is based on the best information available as of 5/9/19.