CommercialCoverageMedium impact
Electrocochleogram and Perilymphatic Pressure Measurement (CPB 0564, reviewed 2026-07-30)
Aetna·Audiology, ENT (Ear, Nose & Throat)·Medical Policy
Effective date
Jul 30, 2026
We identified it
Aug 14, 2026
Summary
Aetna updated its medical policy on electrocochleography (CPT 92584) to clarify coverage criteria. The procedure is now covered ONLY when used for: (1) evaluation of episodic dizziness/vertigo/tinnitus to rule out Meniere's disease or perilymphatic fistula, or (2) when performed with ABR testing in patients with profound hearing loss (PTA ≥90 dB HL). Multiple other indications—including pre-implantation counseling, routine screening, intraoperative use during cochlear implant surgery, and perilymphatic pressure measurement—are explicitly classified as experimental/investigational and NOT covered.
Action Required
By July 30, 2026: Billing team must update claim submission logic and provider education materials to reflect new coverage restrictions for CPT 92584 (Electrocochleography). REQUIRED ACTIONS: (1) In billing software, flag CPT 92584 claims for prior authorization review—claims must include documented evidence of either (a) symptoms of episodic dizziness/vertigo/tinnitus with clinical indication to rule out Meniere's disease or perilymphatic fistula, OR (b) profound hearing loss (PTA ≥90 dB HL at 500, 1000, 2000, 4000 Hz) performed with concurrent ABR testing (CPT 92651-92653). (2) DENY all claims for CPT 92584 when used for: pre-implantation counseling for cochlear implants, routine hearing screening, intraoperative monitoring during cochlear implantation, or perilymphatic pressure measurement—these are experimental/investigational. (3) Update provider encounter templates and billing guidelines to educate audiology and ENT providers on allowable indications. (4) Communicate to providers that claims lacking proper medical necessity documentation will be denied. (5) Verify all related codes (92587, 92588, 92650-92653, 69930, 70540, 70542) are linked appropriately in authorization workflows. Failure to implement will result in claim denials and provider dissatisfaction.