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When you visit a doctor or hearing specialist, your care is recorded and billed using a standardized coding system. These codes are known as CPT, HCPCS, and ICD-10 codes. They ensure that medical services are documented consistently and that insurance claims are processed correctly.
Below, we’ll explore what these codes represent to help clarify medical bills, improve communication with providers, and reduce confusion when reviewing explanations of benefits (EOBs).
Current Procedural Terminology (CPT) codes are numeric or alphanumeric identifiers used to describe medical, surgical, and diagnostic services. These codes are essential for tracking what procedures or services were performed during a healthcare visit. [1]
In hearing care and audiology, CPT codes describe the specific test, fitting, or service performed. For example, some entries relate to a hearing screening CPT code as well as hearing aid fitting CPT codes. Each represents a distinct clinical service, such as:
These designations allow insurers to determine coverage and reimbursement levels. From a consumer’s perspective, they ensure transparency—confirming that the procedures billed align with the care received.
Insurance can be confusing! Check whether your insurance covers hearing care with Amplifon’s handy insurance benefit checker.
Healthcare Common Procedure Coding System (HCPCS) codes (pronounced “hick-picks”) expand on CPT codes and are primarily used by Medicare, Medicaid, and other insurance carriers to describe products, supplies, and certain services not included in the CPT list. [2]
While CPT focuses on professional services, HCPCS covers durable medical equipment, prosthetics, and hearing aid components. For example, HCPCS codes are often used when billing for devices themselves, rather than for testing or fitting services. That means if you purchase or repair a hearing aid through a provider, it’s typically logged with an HCPCS identifier.
For patients, HCPCS codes are important because they specify which parts or supplies were billed separately from the provider’s time or service. If you ever notice a distinction between “fitting service” and “device cost” on a claim, that’s the CPT/HCPCS division in action.
ICD-10, or the International Classification of Diseases, 10th Revision, identifies diagnoses and medical conditions rather than procedures. These codes describe why a service was provided such as the presence of hearing loss, tinnitus, or other auditory conditions. [3]
When a provider files a claim, the ICD-10 code communicates the patient’s medical need for the service. Together with CPT and HCPCS codes, it forms a complete picture for managed care:
This triad ensures insurance systems can review, approve, and reimburse care accurately while maintaining consistency across clinics and providers.
In managed care systems, such as private insurance networks, Medicare, or employer-sponsored plans, coding enables structured data sharing between providers and payers. When you undergo an audiology evaluation, for instance:
Together, these codes tell the insurer what was done, why it was done, and what physical items were provided. They also ensure compliance with national standards and enable accurate reimbursement based on medical necessity and insurance policy rules.
Understanding these systems can empower patients to be active participants in their hearing health journey.
For example, someone undergoing a hearing screening CPT code in a primary care office might later have a hearing test CPT code performed by an audiologist for a more detailed evaluation. Later, if they pursue hearing aids, those services and devices would appear under corresponding hearing aid CPT codes or HCPCS codes within their health plan. Throughout this process, proper coding ensures continuity of care, appropriate billing, and accurate insurance documentation from their health plan.
While the terminology may seem technical, CPT, HCPCS, and ICD-10 codes form the foundation of communication between healthcare providers and health plans. They make modern managed care possible, ensuring that every test, device, and diagnosis is recognized in a standardized way.
For consumers seeking hearing health services, understanding the difference between these codes makes billing statements less intimidating and helps you navigate your insurance benefits with confidence.
Request an appointment at a hearing care provider near you.
Sources
1. American Medical Association. CPT Codes. Retrieved from The American Medical Association.
2. Centers for Medicare & Medicaid Services. Healthcare Common Procedure Coding System (HCPCS). Retrieved from the Centers for Medicare & Medicaid Services.
3. Centers for Disease Control and Prevention. ICD-10-CM Official Guidelines for Coding and Reporting. Retrieved from the CDC.
