CPT 69210Surgery

Remove impacted ear wax uni

CPT code 69210 covers the removal of impacted ear wax (cerumen) from one ear using instruments. This is performed when ear wax has become hardened and blocked the ear canal, causing hearing loss, discomfort, or preventing examination.

Showing rates for

National Average

Base Medicare rate

$46.58

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.61

PE RVU (NF)

0.76

MP RVU

0.07

Total RVU

1.44

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document impaction specifically. The medical record must clearly state the cerumen is 'impacted' not just present. Describe the degree of occlusion (partial vs complete) and method of removal.
Impact: Lack of impaction documentation is the #1 denial reason. Proper documentation can prevent 80-90% of denials and support the $46.58 payment.
Bill bilaterally with modifier 50 when both ears treated. Do not bill 69210 twice on separate lines.
Impact: Correct bilateral billing yields approximately $69.87 vs potential denial or incorrect payment. Billing on two lines may result in second claim being denied as duplicate.
Use modifier 25 appropriately when an E/M is performed. The E/M must address a separate complaint or problem beyond the decision to remove wax.
Impact: Can add $46-$186 for E/M levels 99212-99214 when properly documented. Overuse triggers audits; underuse loses legitimate revenue.
Verify the procedure was actually performed by the billing provider. Cerumen removal by nursing staff during an E/M is not separately billable.
Impact: Incident-to rules apply. Improper billing can result in recoupment of $46.58 plus potential fraud investigation.
Check payer-specific policies. Some Medicare MACs and commercial payers consider 69210 bundled into E/M visits or require specific diagnosis codes.
Impact: Payer policies vary significantly. Some consider 69210 never separately payable with E/M. Know your top 10 payers' rules to avoid denials.
For preventive visits, consider if cerumen removal converts the visit to diagnostic. When impaction is discovered during preventive exam, may need to split bill with modifier 25 on preventive code.

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 69210 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 69210 is $46.58 in non-facility settings and $31.05 in facility settings. Actual payment may vary based on geographic location and the Medicare Administrative Contractor (MAC) locality adjustments.

Can CPT 69210 be billed with an office visit on the same day?

Yes, CPT 69210 can be billed with an E/M service on the same day when modifier 25 is appended to the E/M code, but only if the E/M represents a separate, significant, and identifiable service beyond the decision to remove cerumen. The E/M must address other complaints or conditions, not simply the ear wax removal.

How do you bill CPT 69210 for both ears?

When cerumen removal is performed on both ears during the same encounter, report CPT 69210 once with modifier 50 (bilateral procedure). Do not bill 69210 twice on separate lines. Some payers may require modifiers RT and LT on separate lines instead of modifier 50; verify payer-specific requirements.

What diagnosis codes support medical necessity for CPT 69210?

The primary diagnosis code is H61.23 (impacted cerumen, bilateral), H61.22 (impacted cerumen, left ear), or H61.21 (impacted cerumen, right ear). Supporting secondary diagnoses may include H91.90 (hearing loss), H93.19 (tinnitus), or symptoms caused by the impaction. The diagnosis must support that the cerumen is impacted, not merely present.

What does 'impacted' cerumen mean for coding purposes?

Impacted cerumen means the ear wax has accumulated to the point where it obstructs the ear canal, adheres to the canal wall or tympanic membrane, cannot be removed by the patient through normal hygiene, and requires instrumental removal by a healthcare professional. Simple presence of ear wax does not constitute impaction and does not support billing 69210.

Is CPT 69210 unilateral or bilateral?

CPT 69210 is inherently a unilateral code, as indicated by 'uni' in the descriptor 'Remove impacted ear wax uni.' When the procedure is performed bilaterally, you must append modifier 50 or use RT/LT modifiers as required by the payer to indicate both ears were treated.

Can nurses or medical assistants perform cerumen removal and bill CPT 69210?

Clinical staff may perform cerumen removal under appropriate supervision, but billing requirements vary by payer. For Medicare, the service must meet 'incident-to' requirements: performed under direct supervision of the physician, following physician order, and the supervising physician must be immediately available. The physician must bill the service. Some states restrict scope of practice for specific clinical staff.