Automated Audiometry

Number: 0870


Aetna considers automated audiometry that is either self-administered or administrated by non-audiologists experimental and investigational because its effectiveness has not been adequately validated to be equivalent to audiometry performed by an audiologist.


A limited number of studies have compared computer-assisted audiometry that is self-administered or administered by non-audiologists to audiometry administered by an audiologist. 

Mahomed et al (2013) conducted a meta-analysis of studies reporting within-subject comparisons of manual and automated threshold audiometry.  The authors found overall average differences between manual and automated air conduction audiometry to be comparable with test-retest differences for manual and automated audiometry.  The authors found, however, limited data on automated audiometry in children and difficult-to-test populations, automated bone conduction audiometry, and data on the performance of automated audiometry in different types and degrees of hearing loss.

The American Speeh-Language Hearing Association (2013) recommends that hearing screening be conducted under the supervision of an audiologist holding the ASHA Certificate of Clinical Competence (CCC).

In a prospective diagnostic study, Foulad et al (2103) determined the feasibility of an Apple iOS-based automated hearing testing application and compared its accuracy with conventional audiometry.  An iOS-based software application was developed to perform automated pure-tone hearing testing on the iPhone, iPod touch, and iPad.  To assess for device variations and compatibility, preliminary work was performed to compare the standardized sound output (dB) of various Apple device and headset combinations.  A total of 42 subjects underwent automated iOS-based hearing testing in a sound booth, automated iOS-based hearing testing in a quiet room, and conventional manual audiometry.  The maximum difference in sound intensity between various Apple device and headset combinations was 4 dB.  On average, 96 % (95 % confidence interval [CI]: 91 % to 100 %) of the threshold values obtained using the automated test in a sound booth were within 10 dB of the corresponding threshold values obtained using conventional audiometry.  When the automated test was performed in a quiet room, 94 % (95 % CI: 87 % to 100 %) of the threshold values were within 10 dB of the threshold values obtained using conventional audiometry.  Under standardized testing conditions, 90 % of the subjects preferred iOS-based audiometry as opposed to conventional audiometry.  The authors concluded that Apple iOS-based devices provided a platform for automated air conduction audiometry without requiring extra equipment and yielded hearing test results that approach those of conventional audiometry.  This was a feasibility study; its findings need to be validated by well-designed studies.

Khoza-Shangase and Kassner (2013) determined the accuracy of UHear™, a downloadable audiometer on to an iPod Touch©, when compared with conventional audiometry.  Participants were primary school students.  A total number of 86 participants (172 ears) were included.  Of these 86 participants, 44 were females and 42 were males; with the age ranging from 8 years to 10 years (mean age of 9.0 years).  Each participant underwent 2 audiological screening evaluations; one by means of conventional audiometry and the other by means of UHear™.  Otoscopy and tympanometry was performed on each participant to determine status of their outer and middle ear before each participant undergoing pure tone air conduction screening by means of conventional audiometer and UHear™.  The lowest audible hearing thresholds from each participant were obtained at conventional frequencies.  Using the paired t-test, it was determined that there was a significant statistical difference between hearing screening thresholds obtained from conventional audiometry and UHear™.  The screening thresholds obtained from UHear™ were significantly elevated (worse) in comparison to conventional audiometry.  The difference in thresholds may be attributed to differences in transducers used, ambient noise levels and lack of calibration of UHear™.  The authors concluded that the UHear™ is not as accurate as conventional audiometry in determining hearing thresholds during screening of school-aged children.  Moreover, they stated that caution needs to be exercised when using such measures and research evidence needs to be established before they can be endorsed and used with the general public.

CPT Codes / HCPCS Codes / ICD-9 Codes
CPT codes not covered for indications listed in the CPB:
0208T Pure tone audiometry (threshold), automated; air only [without an audiologist]
0209T     air and bone [without an audiologist]
CPT Codes / HCPCS Codes / ICD-10 Codes
Information in the [brackets] below has been added for clarification purposes.   Codes requiring a 7th character are represented by "+":
ICD-10 codes will become effective as of October 1, 2015:
CPT codes not covered for indications listed in the CPB:
0208T Pure tone audiometry (threshold), automated; air only [without an audiologist]
0209T     air and bone [without an audiologist]

The above policy is based on the following references:
    1. Mahomed F, Swanepoel DW, Eikelboom RH, Soer M. Validity of automated threshold audiometry: A systematic review and meta-analysis. Ear Hear. 2013;34(6):745-752.
    2. Yu J, Ostevik A, Hodgetts B, Ho A. Automated hearing tests: Applying the otogram to patients who are difficult to test. J Otolaryngol Head Neck Surg. 2011;40(5):376-383.
    3. Swanepoel de W, Mngemane S, Molemong S, et al. Hearing assessment-reliability, accuracy, and efficiency of automated audiometry. Telemed J E Health. 2010;16(5):557-563.
    4. Margolis RH, Glasberg BR, Creeke S, Moore BC. AMTAS: Automated method for testing auditory sensitivity: Validation studies. Int J Audiol. 2010;49(3):185-194.
    5. Ho AT, Hildreth AJ, Lindsey L. Computer-assisted audiometry versus manual audiometry. Otol Neurotol. 2009;30(7):876-883.
    6. American Speech-Language-Hearing Association (ASHA). Hearing screening and testing. Information for the Public. Rockville, MD: ASHA; 2013.
    7. Foulad A, Bui P, Djalilian H. Automated audiometry using apple iOS-based application technology. Otolaryngol Head Neck Surg. 2013;149(5):700-706.
    8. Khoza-Shangase K, Kassner L. Automated screening audiometry in the digital age: Exploring Uhear™ and its use in a resource-stricken developing country. Int J Technol Assess Health Care. 2013;29(1):42-47.

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