Aetna modified CPB 0564 covering electrocochleography (ECOG) under CPT 92584, effective September 26, 2025. Here's what billing teams need to do.
Aetna, a CVS Health company, updated its electrocochleography coverage policy under CPB 0564 Aetna system on September 26, 2025. The policy governs when CPT 92584—electrocochleography—is covered for Aetna members. Two clinical indications determine coverage: episodic dizziness or tinnitus workups for endolymphatic hydrops and perilymphatic fistula, and pre-cochlear implant evaluations paired with auditory brainstem response testing. If your practice handles audiology billing, otolaryngology billing, or neurotology billing, this policy directly affects your claim approval rates.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna |
| Policy | Electrocochleogram and Perilymphatic Pressure Measurement |
| Policy Code | CPB 0564 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | Medium |
| Specialties Affected | Audiology, Otolaryngology (ENT), Neurotology |
| Key Action | Verify all CPT 92584 claims map to one of two covered indications before billing |
Aetna Electrocochleography Coverage Criteria and Medical Necessity Requirements 2025
Aetna's coverage policy for electrocochleography under CPB 0564 covers CPT 92584 under exactly two scenarios. Get one of these wrong and you're looking at a claim denial.
Indication 1: Episodic Dizziness or Tinnitus Workup
Aetna covers ECOG (CPT 92584) when a member presents with episodic dizziness—vertigo or imbalance—or tinnitus, and the study is performed to rule out endolymphatic hydrops (Meniere's disease) or perilymphatic fistula. The applicable diagnosis codes here span Meniere's disease (H81.1 through H81.9), vertigo (H81.10–H81.13, H81.311–H81.49), tinnitus (H93.11–H93.19, H93.A1–H93.A9), labyrinthine fistula (H83.11–H83.19), dizziness (R42), and imbalance (R26.89).
This is the most common billing pathway for electrocochleography. Your documentation needs to clearly establish episodic symptoms—not chronic, non-episodic vestibular complaints. Medical necessity hinges on whether the ECOG is being used diagnostically to differentiate between these two conditions. If your clinical notes don't use that framing, expect pushback.
Indication 2: Profound Hearing Loss Evaluation with ABR
Aetna also covers CPT 92584 when performed alongside auditory brainstem response (ABR) testing for members with profound hearing loss. Here's the threshold that matters: profound hearing loss means a pure tone average (PTA) of 90 dB HL or greater at 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz—across all four frequencies.
This is typically a pre-cochlear implant evaluation pathway. The relevant ABR codes in this context include CPT 92651 (for hearing status determination), 92652 (threshold estimation at multiple frequencies), and 92653 (neurodiagnostic). The ICD-10 codes that support this indication include H90.3 (sensorineural hearing loss, bilateral), H90.5 (unspecified sensorineural hearing loss), H90.6–H90.8 (mixed conductive and sensorineural hearing loss), H91.20–H91.23 (sudden idiopathic hearing loss), and Z01.118 and Z01.12 for pre-implant counseling encounters.
Don't bill CPT 92584 alone in this scenario. Aetna expects it paired with an ABR code. A standalone ECOG claim for a profound hearing loss patient—without ABR—won't meet medical necessity under this indication.
Prior Authorization
The policy doesn't explicitly enumerate prior authorization requirements within the CPB 0564 text itself. That said, prior auth requirements for audiology procedures under Aetna vary by plan. Check the member's specific plan documents before scheduling. Don't assume commercial Aetna plans mirror Medicare Advantage requirements on this one.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Episodic dizziness/vertigo to rule out endolymphatic hydrops or perilymphatic fistula | Covered | CPT 92584; ICD-10 H81.1–H81.9, H81.10–H81.13, H81.311–H81.49, H83.11–H83.19, R42, R26.89 | Must document episodic symptoms; tinnitus also qualifying |
| Tinnitus workup to rule out Meniere's disease or perilymphatic fistula | Covered | CPT 92584; ICD-10 H93.11–H93.19, H93.A1–H93.A9 | Must link tinnitus to diagnostic purpose for these conditions |
| Profound hearing loss (PTA ≥ 90 dB HL at 500/1K/2K/4K Hz) with ABR testing | Covered | CPT 92584 + 92651/92652/92653; ICD-10 H90.3, H90.5, H90.6–H90.8, H91.20–H91.23, Z01.118, Z01.12 | ABR must be billed concurrently; standalone ECOG not supported |
| Routine hearing screening without signs or symptoms | Not Covered | ICD-10 Z01.10, Z01.110 | These Z-codes appear in the policy but do not support ECOG coverage |
| ECOG for indications outside the two covered criteria | Not Covered | — | No other indications are recognized in CPB 0564 |
Aetna Electrocochleography Billing Guidelines and Action Items 2025
The real issue here is documentation specificity. ECOG is a narrow, procedure-specific code. Aetna isn't going to approve CPT 92584 on a vague vestibular complaint. Here's what your billing team should do before September 26, 2025.
| # | Action Item |
|---|---|
| 1 | Audit your CPT 92584 charge capture now. Pull the last 90 days of 92584 claims and confirm each one maps to one of the two covered indications. Claims that don't will give you a preview of what denials look like under the updated policy. |
| 2 | Update your ABR pairing protocol for profound hearing loss cases. If you bill CPT 92584 for pre-cochlear implant evaluations, confirm it's always paired with an appropriate ABR code—92651, 92652, or 92653—and that the PTA documentation shows ≥ 90 dB HL at all four frequencies (500 Hz, 1,000 Hz, 2,000 Hz, 4,000 Hz). Missing any single frequency from the audiogram documentation is a medical necessity documentation failure. |
| 3 | Train clinicians on episodic vs. non-episodic symptom documentation. The first indication requires episodic dizziness or tinnitus. Encourage your otolaryngology and audiology providers to use language like "episodic vertigo" or "episodic tinnitus" explicitly in the clinical note—not just "dizziness" or "hearing changes." That language distinction drives reimbursement. |
| 4 | Map your ICD-10 codes against the covered list. Cross-reference your practice's common diagnosis codes for Meniere's disease, tinnitus, vertigo, and hearing loss against the ICD-10 codes listed in CPB 0564. If you're using laterality-specific codes (e.g., H81.11, H81.12, H81.13 for right, left, bilateral), confirm those specific codes appear in the covered list. The policy includes the full H81 category, but documentation should match. |
| 5 | Flag Z-code encounters for manual review. Patients presenting under Z01.10 (routine hearing exam, no abnormal findings) or Z01.110 (hearing exam following failed screening) are not good candidates for CPT 92584 under this policy. If ECOG is being considered for a routine screening encounter, that's a claim denial waiting to happen. Route those cases to your compliance officer for review. |
| 6 | Verify prior authorization requirements plan by plan. Aetna's commercial plans, Medicare Advantage plans, and self-insured employer plans may have different prior auth requirements for 92584. Don't assume uniformity. If you're unsure how prior authorization applies to a specific member's plan, confirm with Aetna before the procedure date. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Electrocochleography Under CPB 0564
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 92584 | CPT | Electrocochleography |
Other CPT Codes Related to CPB 0564
These codes appear in the policy and support related procedures or the clinical context of ECOG. They are not independently covered by CPB 0564 but appear in associated billing scenarios.
| Code | Type | Description |
|---|---|---|
| 69930 | CPT | Cochlear device implantation, with or without mastoidectomy |
| 70540 | CPT | MRI, orbit, face, and/or neck; without contrast material(s) |
| 70542 | CPT | MRI, orbit, face, and/or neck; with contrast material(s) |
| 92587 | CPT | Evoked otoacoustic emissions; limited (single stimulus level, either transient or distortion product) |
| 92588 | CPT | Evoked otoacoustic emissions; comprehensive or diagnostic evaluation |
| 92650 | CPT | Auditory evoked potentials; screening with broadband stimuli, automated analysis |
| 92651 | CPT | Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report |
| 92652 | CPT | Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report |
| 92653 | CPT | Auditory evoked potentials; neurodiagnostic, with interpretation and report |
Key ICD-10-CM Diagnosis Codes
| Code | Description |
|---|---|
| H81.1–H81.9 | Meniere's disease (various) |
| H81.10–H81.13 | Benign paroxysmal vertigo |
| H81.311–H81.49 | Other peripheral vertigo |
| H83.11–H83.19 | Labyrinthine fistula (laterality variants) |
| H83.3X1–H83.3X9 | Noise effects on inner ear |
| H90.3 | Sensorineural hearing loss, bilateral |
| H90.41 | Sensorineural hearing loss, unilateral, with unrestricted hearing on contralateral side (right) |
| H90.42 | Sensorineural hearing loss, unilateral, with unrestricted hearing on contralateral side (left) |
| H90.5 | Unspecified sensorineural hearing loss |
| H90.6 | Mixed conductive and sensorineural hearing loss, bilateral |
| H90.7 | Mixed conductive and sensorineural hearing loss, unilateral |
| H90.8 | Mixed conductive and sensorineural hearing loss, unilateral |
| H90.A11–H90.A12 | Conductive hearing loss, unilateral, with restricted hearing on contralateral side |
| H91.20 | Sudden idiopathic hearing loss, unspecified ear |
| H91.21 | Sudden idiopathic hearing loss, right ear |
| H91.22 | Sudden idiopathic hearing loss, left ear |
| H91.23 | Sudden idiopathic hearing loss, bilateral |
| H91.8X1–H91.8X9 | Other specified hearing loss |
| H93.11–H93.19 | Tinnitus (laterality variants) |
| H93.A1–H93.A9 | Pulsatile tinnitus |
| R26.89 | Other abnormalities of gait and mobility (imbalance) |
| R42 | Dizziness and giddiness |
| S09.91xA–S09.91xS | Unspecified injury of ear (cochlear trauma) |
| Z01.10 | Encounter for examination of ears and hearing without abnormal findings |
| Z01.110 | Encounter for hearing examination following failed hearing screening |
| Z01.118 | Encounter for examination of ears and hearing with other abnormal findings |
| Z01.12 | Encounter for hearing conservation and treatment |
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