Return on Investment with OtoClear^® Safe Irrigation Tips

CPT Code 69210 - Removal impacted cerumen (separate procedure), 1 or both ears

Non-Facility
Average Medicare Reimbursement Per Procedure** ------------------------ $49.95
Amount of Procedures Performed with a Box of 40 tips --------------------- x 40
Break Even (Procedures) ------------------------------------------------------------ 2.38
Revenue Generated with 40 Tips ------------------------------------------------- $1,998.00
Minus the Cost of the Ear Lavage System (40 OtoClear Tips, 1 Portable
Waterpik® Unit, 3 Adapter Wands and 1 Irrigation Basin)***---------------- $119.00
TOTAL RETURN ON INVESTMENT ---------------------------------------------- $1,879.00

Facility
Average Medicare Reimbursement Per Procedure** ---------------------- $32.62
Break Even (Procedures) ----------------------------------------------------------- 3.65
TOTAL RETURN ON INVESTMENT --------------------------------------------- $1,879.00

CPT Code 69200 - Removal foreign body from external auditory canal; without general anesthesia

Non-Facility
Average Medicare Reimbursement Per Procedure** ----------------------- $122.32
Amount of Procedures Performed with a Box of 40 tips --------------------- x 40
Break Even (Procedures) ----------------------------------------------------------- 1.03
Revenue Generated with 40 Tips ------------------------------------------------ $4,892.80
Minus the Cost of the Ear Lavage System (40 OtoClear Tips, 1 Portable
Waterpik® Unit, 3 Adapter Wands and 1 Irrigation Basin)***--------------- $119.00
TOTAL RETURN ON INVESTMENT --------------------------------------------- $4,773.80

Facility
Average Medicare Reimbursement Per Procedure** ---------------------- $57.08
Break Even (Procedures) ----------------------------------------------------------- 2.08
TOTAL RETURN ON INVESTMENT --------------------------------------------- $2,164.20

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CPT Code 69210 - Removal impacted cerumen (separate procedure), 1 or both ears

Non-Facility
Average Medicare Reimbursement Per Procedure** ----------------------- $49.95
Amount of Procedures Performed with a Box of 50 tips --------------------- x 50
Break Even (Procedures) ----------------------------------------------------------- 1.59
Revenue Generated with 50 Tips ------------------------------------------------- $2,497.50
Minus the Cost of 50 Tips & 1 Light Source*** ---------------------------------- $79.50
TOTAL RETURN ON INVESTMENT ---------------------------------------------- $2,418.00

Facility
Average Medicare Reimbursement Per Procedure** ----------------------- $32.62
Break Even (Procedures) ------------------------------------------------------------ 2.44
TOTAL RETURN ON INVESTMENT ---------------------------------------------- $2,418.00

CPT Code 69200 - Removal foreign body from external auditory canal; without general anesthesia

Non-Facility
Average Medicare Reimbursement Per Procedure** ----------------------- $122.32
Amount of Procedures Performed with a Box of 50 tips --------------------- x 50
Break Even (Procedures) ------------------------------------------------------------ 1.54
Revenue Generated with 50 Tips ------------------------------------------------- $6,116.00
Minus the Cost of 50 Tips & 1 Light Source*** --------------------------------- $79.50
TOTAL RETURN ON INVESTMENT --------------------------------------------- $6,036.50

Facility
Average Medicare Reimbursement Per Procedure** ----------------------- $57.08
Break Even (Procedures) ------------------------------------------------------------ 1.3
TOTAL RETURN ON INVESTMENT ---------------------------------------------- $2,774.50

*Based on 2011 MediCare Fee Shedule. **AMA.org ***Suggested Retail. +Subsequent use requires purchase of 40 tips increasing ROI.
++Facility includes hospitals, ambulatory surgical centers and skilled nursing facilities. +++Non-Facility includes all other settings.

Coding

• 69200, Removal foreign body from external auditory canal; without general anesthesia
• 69210, Removal of impacted cerumen (separate procedure), one or both ears
• G0268, Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing

Average Reimbursement Rate Medicare Payment*
69210
Non Facility* $49.95
Facility $32.62

69200
Non Facility* $122.32
Facility $57.08

https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp?locality=XX

1. Bill 69210 for medically reasonable and necessary removal of impacted cerumen requiring a physician's skill.
2. CPT 69210 and HCPCS G0268 include performance of the procedure for one or both ears and should only be billed once per visit.
3. Bill G0268 only where physician's skill is needed to remove impacted cerumen on the same day as audiologic function testing performed by his/her employed audiologist. If the audiologist removes the cerumen, he/she cannot bill HCPCS code G0268 or CPT code 69210. In such case, cerumen removal does not require a physician's skill and is considered to be included in the payment for the audiologic testing.
4. HCPCS code G0268 must be billed on the same claim as the audiologic function test(s) done.
5. HCPCS code G0268 is subject to the multiple surgery rule when billed with other surgical procedure(s) done on the same date of service.

Reference: CMS Centers for Medicare & Medicaid services. For reference only. Information is based on 2011 Medicare Fee Schedule and does not guarantee payment coverage.

Additional Reimbursement Information:

• An E&M service may be billed on the same day as 69210 or G0268 only if documentation supports it to be a significant, separately identifiable service by the same physician on the same day as the procedure. In such cases modifier -25 should be added to the E&M code.
• CMS will consider payment for both an E&M visit and the cerumen removal only when all criteria below are met:

a. The nature of the E&M visit is for anything other than the removal of cerumen;
b. During an unrelated patient encounter, the physician observes impacted cerumen or the patient lodges a specific
complaint about his/her ear during the encounter;
c. Otoscopic examination of the tympanic membrane is not possible due to the impaction;
d. Removal of the impacted cerumen requires the expertise of the physician or non-physician practitioner and is
personally performed by them; and
e. The procedure requires a significant amount of time and effort and all of the above criteria are clearly documented
in the patient’s medical record.


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