What is CPT 69210?

Removal of cerumen, in simple words removal of ear wax, most of the insurance will not cover for ear wax removal, and all the insurance will deny the procedure stating it is included procedure with office visit. 

following are the Medicare guidelines to bill Removal of cerumen procedure.

·         Cerumen removal is the only reason for the visit.

·         Cerumen removal is performed personally by a physician or midlevel provider.

·         The patient is symptomatic (pain, pressure, poor hearing, etc.) from excessive cerumen.

·         Cerumen removal requires more than drops, cotton swabs, and cerumen spoon.

·         Documentation in the patient record shows that the procedure required significant time and effort.

Medicare will not cover along with the E&M code until above mentioned points are met, still we need bill G0268 for Medicare and 69210 for all other commercial carriers. 

And ICD – 9 (dx) -380.4 code for 69210 along with 25 modifier for office visit.