CPT Code 69210: Removal Impacted Cerumen (One Ear)

Use CPT code 69210 for unilateral impacted cerumen removal. Read the article for insights, including documentation guidelines, billing tips, and modifiers.

Use Code

Frequently asked questions

Yes, Medicare covers CPT code 69210 if documentation demonstrates clear medical necessity, such as ear pain, hearing impairment, or obstructed visualization of the tympanic membrane. Coverage typically aligns with an applicable Local Coverage Determination (LCD). Medicare may deny claims lacking adequate documentation or when removal is considered routine.

CPT 69209 represents removal of cerumen by simple lavage or irrigation methods without instrumentation, whereas CPT 69210 specifically requires instrumentation (e.g., curette, suction, forceps) under direct visualization. Billing 69210 necessitates documentation demonstrating significant cerumen impaction and medical necessity.

CPT 69210 is billed once per ear per encounter. If both ears require instrumentation removal, bill once with modifier -50 (bilateral) or use separate lines with modifiers -RT and -LT, as per payer guidance. Routine repeated billing without documented medical necessity may result in denials.