The August 2026 issue of CPT® Assistant provides clarification on coding for insertion and removal of tympanostomy, or pressure equalizing (PE), tubes.

The guidance helps distinguish the available coding options based on the type of anesthesia used, whether an automated tube delivery system is used, where the tube is removed, and whether another procedure is performed at the same time.

When I review coding guidance like this, I do not look at CPT® Assistant in isolation. My approach is to compare the clarification with the current CPT® guidelines, applicable payer policies, and guidance from the relevant specialty society. Reviewing these sources together helps identify where guidance is consistent, where payer requirements may differ, and where specialty-specific recommendations provide additional context for coding and documentation.

For ENT practices, the August clarification is also a good reason to review procedure-note templates and make sure the documentation clearly supports how the service was performed.

Office-Based PE Tube Placement

There are different coding pathways for PE tube placement performed in the physician office. The correct code depends on the anesthesia technique and the equipment used.

Iontophoresis With an Automated Tube Delivery System

When the physician uses a combined iontophoresis topical anesthetic system with an automated tympanostomy tube delivery system, CPT® Assistant instructs providers to report 0583T only.

Code 0583T includes the equipment and procedural work from administration of anesthesia through iontophoresis through placement of the tube using the automated delivery system.

The code is unilateral. When the procedure is performed bilaterally, CPT® Assistant directs providers to append modifier 50.

Documentation example:

“Topical anesthesia was administered to the right tympanic membrane using iontophoresis. Following adequate anesthesia, an automated tympanostomy tube delivery system was used to create the tympanostomy and place the ventilation tube.”

For a bilateral service, the documentation should clearly identify that the procedure was performed on both ears.

Example:

“Iontophoresis topical anesthesia was administered bilaterally. Automated tympanostomy tube placement was then performed in both the right and left ears.”

When 0583T is reported, 69433 and G0561 should not also be reported for the same ear.

Automated Tube Placement Without Iontophoresis

When an automated tympanostomy tube delivery system is used with local or topical anesthesia that does not involve iontophoresis, CPT® Assistant directs providers to report:

69433 + G0561

In this situation, 69433 represents the tympanostomy with tube placement, while G0561 represents the additional expense associated with the automated tube delivery system.

CMS established separate payment for G0561 for calendar year 2026.

Documentation example:

“Topical phenol anesthesia was applied to the right tympanic membrane. A tympanostomy was created and a ventilation tube was inserted using an automated tube delivery device. Iontophoresis was not used.”

The procedure note should make both elements clear:

• The type of anesthesia used
• Whether an automated tube delivery system was used

Documentation that simply states “PE tube placed in office” may not give the coding team enough information to determine whether 69433, 69433 with G0561, or 0583T is appropriate.

Document the Technique, Not Just the Procedure

With multiple coding options available, the documentation should describe how the procedure was performed rather than simply state that a tube was placed.

Instead of:

“Bilateral tubes placed.”

Consider documentation such as:

“Topical local anesthesia was applied to each tympanic membrane. Tympanostomy with ventilation tube placement was performed bilaterally using an automated tube delivery system. Iontophoresis was not utilized.”

Or, when iontophoresis is used:

“Iontophoresis was used to administer topical anesthesia prior to automated tympanostomy tube placement.”

That additional detail gives the coding team the information needed to select the appropriate coding pathway.

PE Tube Removal in the Operating Room

The August CPT® Assistant clarification also addresses PE tube removal.

When tube removal requires general anesthesia and is performed in the operating room, CPT® Assistant directs providers to report 69424.

Documentation example:

“Under general anesthesia, the retained ventilation tube was identified in the left tympanic membrane and removed.”

The documentation should support both the removal of the tube and the use of general anesthesia.

PE Tube Removal in the Office

When a PE tube is removed in the office without general anesthesia, the August guidance directs providers to report 69200.

The clarification relies on the CPT® definition addressing circumstances in which an implant may qualify as a foreign body for coding purposes, including when it has moved from its original position, is structurally broken, no longer serves its intended purpose, or presents a hazard.

Documentation example:

“Retained PE tube was noted in the right external auditory canal and was no longer functioning as intended. The tube was removed in the office without general anesthesia using alligator forceps.”

The note should clearly describe the location and status of the tube as well as the removal performed.

Binocular Microscopy

If binocular microscopy is used during tube removal, 92504 may be separately reported when supported by the documentation and applicable coding requirements.

The note should specifically document the use of binocular microscopy.

Documentation example:

“Under binocular microscopy, the retained PE tube was visualized in the left external auditory canal and removed with instrumentation.”

The documentation should distinguish the microscopy work from the tube-removal service itself.

Tube Removal With Tympanic Membrane Repair

If a PE tube is removed from the same ear on the same date as a tympanic membrane repair, the removal is considered inherent to the repair and is not separately reported.

For example, when the physician removes the tube and performs a tympanic membrane repair reported with 69610, CPT® Assistant instructs providers to report only the repair procedure.

Documentation example:

“The retained ventilation tube was removed from the right tympanic membrane. The residual perforation was freshened and repaired with a paper patch.”

In this scenario, the removal is part of the repair service.

My Approach to Reviewing This Guidance

CPT® Assistant provides important clarification, but I recommend looking at the full coding picture before changing a billing or documentation process.

For PE tube services, I would compare the August 2026 clarification with:

• The current CPT® code descriptors, parenthetical instructions, and applicable guidelines
• CMS guidance and National Correct Coding Initiative edits, when applicable
• Medicare Administrative Contractor guidance
• Commercial payer medical and reimbursement policies
• Guidance from the applicable specialty society, including otolaryngology resources
• The organization’s existing documentation and coding policies

These sources do not always address a service in exactly the same way. A payer may have billing requirements that are more restrictive than CPT®, or a specialty society may provide additional clinical or documentation guidance.

The goal is to understand how the sources work together before changing coding practices.

Documentation Review Points

For tympanostomy tube placement and removal, I would look for documentation that clearly identifies:

• Right ear, left ear, or bilateral service
• Type of anesthesia used
• Whether iontophoresis was used
• Whether an automated tube delivery system was used
• Location and condition of the tube when it is removed
• Whether general anesthesia was used
• Whether binocular microscopy was performed
• Whether a tympanic membrane repair or another procedure was performed at the same encounter

The August 2026 CPT® Assistant clarification gives practices additional direction on these services, but accurate code selection still depends on complete documentation and review of the applicable CPT®, payer, and specialty-specific guidance.

Source: Coding Clarification: Insertion and Removal of Tympanostomy Tubes. CPT® Assistant, August 2026, page 7.

CPT® is a registered trademark of the American Medical Association. This article is intended for educational purposes and should be reviewed alongside current CPT® guidance, payer policies, specialty-society guidance, and organization-specific requirements.