Is the eardrum pressure test covered by insurance?
Usually yes when your child has an ear complaint. Tympanometry, code 92567, is the quick test where a soft tip in the ear puffs air and measures how the eardrum moves, which tells the doctor whether fluid is sitting behind it. Most plans pay it as a diagnostic test. Some fold it into the office visit and pay nothing extra.
Usually
Covered with an ear complaint on file
Bundled or paid
Most plans pay tympanometry as its own line. A few bundle it into the visit fee, and under most in network contracts the family cannot be billed the difference.
Both ears, one fee
Most payers treat the code as covering the test, not each ear, so both sides still go on the claim as a single unit.
Deductible line
Parents expect one copay to cover the whole visit. On a deductible plan the test lands on the family until that deductible is met.
Check first
The eligibility check shows plan status, deductible left and copay before the visit, so the desk explains the extra line instead of arguing about it later.
What would a real check show for this patient's 92567?
Pick a sample plan and type your fee. This is the visibility a real-time check gives the desk for every actual patient, in under a second.
Eligibility readout · 92567
Sample- Coverage
- Active, $30 office copay, referral needed for ENT
- Frequency
- No limit when an ear diagnosis is on the claim
- Patient share
- Type your fee to see it
Estimate from a sample plan. A real check reads the actual plan in under a second.
When 92567 is the right code
- The child has an ear complaint or a fluid recheck
- An actual tracing is produced, not just a look inside
- The provider reads the tracing and writes an interpretation
- The result changes what happens at that visit
- Usually one unit per visit, one ear or both
Documentation payers expect
Payers want the ear symptom or fluid diagnosis in the note, the printed tracing in the chart, and a short signed reading. If an office visit is billed the same day, the note has to show that visit stood on its own and carry modifier 25.
Why 92567 gets denied
What happens after the ear test
A flat tracing usually means a recheck in a few weeks, and that second visit brings another 92567 and another copay. If the fluid stays, the ear specialist referral starts a new set of rules, since many plans want a referral on file before that visit pays. Knowing the copay, the deductible left and the referral flag up front keeps all of that off the surprise pile.
92567, quick answers
Why is there a separate charge if we came in for an ear infection?
Tympanometry is its own test with its own code, 92567, so it bills as a separate line from the visit. Most plans pay it, but a deductible plan passes it through to the family first.
Does 92567 count as a hearing test?
No. 92567 measures how the eardrum moves under air pressure. The pass or fail hearing screen is 92551, and a plan can cover one and not the other.
Is it covered at a well child visit?
Usually only when there is an ear complaint that day. With nothing but a preventive diagnosis on the claim, most plans read it as screening and deny it.
Does Medicare cover tympanometry?
Medicare pays 92567 when the test works up an ear problem and the result is read and written up, so a covered ear diagnosis has to be on the claim. It does not cover routine hearing screening or testing done only to fit a hearing aid. In a pediatric office this comes up only for a young adult covered through disability.
Can the office bill us if insurance calls it bundled?
Usually not. When an in network plan bundles the test into the visit, the contract makes it part of the visit fee, so the family owes nothing extra for it.
More questions? Schedule 15 minutes with us and bring your toughest plan.
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Related: 92551 · 69210 · 99213
CPT is a registered trademark of the American Medical Association. This page is Valian's own plain-English summary for front-desk teams, not official CPT descriptor text, and is not billing or clinical advice. Coverage patterns are common plan behaviors; every plan differs. Verify benefits before the visit.