CPT Code 95992
CPT 95992 – Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day
* Source: NGS A56566
Appropriate Diagnosis to Charge CPT Code 95992
- H81.11 – Benign paroxysmal vertigo, right ear
- H81.12 – Benign paroxysmal vertigo, left ear
- H81.13 – Benign paroxysmal vertigo, bilateral
* Source: Novitas-Solutions A57703
Modifier 59
Below is a screenshot from CMS Practitioner PTP Edits v282r0 (663,766 records) 61000/0213T – U0003/U0004 (ZIP) – Effective July 1, 2022; Posted Aug. 2, 2022
This is a zip file containing a text file and MS Excel spreadsheet with two columns of CPT Codes.
How This Works
Column 1 shows the CPT Code 95992 Canalith repositioning procedure and Column 2 shows other services you may be providing on the same date of service.
If a 1 exists in the 6th column then the coding pair is eligible for the addition of a 59 modifier.
For example, if a physical therapist bills CPT Code 95992 and CPT Code 97110 on the same date of service without adding the 59 modifier to the CPT Code 97110 line item then CPT Code 95992 would pay but CPT Code 97110 would not pay.
Coding Pairs Eligible for the 59 Modifier when billed on the same date of service.
| CPT Code 95992 | CPT Code 97110 |
| CPT Code 95992 | CPT Code 97112 |
| CPT Code 95992 | CPT Code 97140 |
| CPT Code 95992 | CPT Code 97530 |
How to Correct a Claim
If you make this mistake, the best way to correct the claim is to log into your MAC portal and reopen the claim and add the 59 modifier to the CPT Code 97110 line item. The claim will reprocess and payment will be made.
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