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June 4, 2014

Removal of Impacted Ear Wax: Claim Submission Information

There has been a recent surge in calls to our Provider Contact Center regarding CPT code 69210 (removal of impacted ear wax). The purpose of this article is to clarify claim submission instructions when this service is performed bilaterally. The 2014 CPT manual revised the description of this CPT code.

For services performed on or after January 1, 2014, CPT states that this code is considered unilateral and may be submitted with CPT modifier 50 to indicate a bilateral service. However, in the CMS Medicare Physician Fee Schedule Database (MPFSDB), CPT code 69210 has a bilateral indicator of 2, which signifies that Medicare payment is based on the service being performed bilaterally.

In this case, follow the instructions and indicators in the MPFSDB. Claim submission instructions:

  • Submit CPT code 69210 with one unit and no modifiers.
  • Do not submit CPT modifier 50 or multiple units.

Claims submitted for CPT code 69210 with CPT modifier 50 will be returned as unprocessable (remark code MA130) and must be corrected and resubmitted as new claims. If the CMS MPFSDB is updated and this information changes, CGS will notify providers through our e-mail list.

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