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CPT code 92586 and newborn hearing test — a technical-only code


CPT code 92586 is a technical-only code (CMS guidelines and Aetna policy) and, as such, can and should be billed only by the hospital/facility and not a third party.  Under your network contract, payment for this newborn hearing test is included in the global code we pay to the hospital, and any claims received by a third party that is subcontracted by the hospital for this service will be denied. 


If your hospital/facility is outsourcing this service to third party providers (whether or not they bring their own equipment into the hospital/facility and perform the test), payment to the third party is the responsibility of the hospital/facility and not Aetna or Aetna® plan sponsors or members. The hospital should immediately advise its third party providers not to bill Aetna or the patient/member(s) for this service; payment for this service to any subcontracted third party provider is to be the responsibility of the hospital/facility, and any equipment and/or services provided by an alternate facility and or vendor/provider during the course of an admission or procedure is the financial responsibility of the Hospital per standard coding guidelines. 


We are respectfully requesting that you immediately advise any and all vendor/provider(s) you have subcontracted with for this service of this policy.