Removal impacted cerumen (separate procedure), one or both ears

CPT 69200 is the billing code for "Removal impacted cerumen (separate procedure), one or both ears". Removal of impacted cerumen from one or both ears

Medicare pays approximately $78.28 for CPT 69200 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.

CPT 69200 has a total RVU of 1.61, broken down as: Work RVU 0.75, Practice Expense RVU 0.80, and Malpractice RVU 0.06. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 69200 include: One or both ears documented; Method of removal documented; Impacted cerumen documented; Patient response to procedure. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 69200: One or both ears. Impacted cerumen only Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 69200 include: 59 (Distinct procedural service when multiple procedures performed), 50 (Bilateral procedure), LT (Left side). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 69200 is Typically 10-15 minutes. Time-based codes require documentation of the actual time spent providing the service.