What this is, in plain language
A short surgery, usually for children, that places tiny tubes in the eardrums to drain fluid and prevent repeat ear infections.
Why a clinician orders it
Frequent ear infections or persistent fluid behind the eardrum affecting hearing.
Medical necessity — what insurers usually look at
Insurers typically require documented infection frequency (such as 3 episodes in 6 months or 4 in a year) or persistent fluid with hearing loss, per AAO-HNS guidelines.
New to this? Read what medical necessity means and how to appeal a denial.
Documentation to ask about
- ✓Number and dates of ear infections or duration of fluid
- ✓Hearing test results if done
- ✓Prior auth approval in writing
Questions for your provider
- ?Does my child meet my plan's criteria for ear tubes?
- ?Has prior auth been approved in writing?
Why this code is in our seed set
One of the most common pediatric surgeries nationally; in the CMS Top 200 Ranked by Services.
Validated against
- •CMS Top 200 Level I CPT Codes Ranked by Services
- •AAO-HNS Clinical Practice Guideline on Tympanostomy Tubes
- •AMA CPT code 69436 descriptor
Terms you'll see
Prior AuthorizationRead more →
Some services may need plan approval before they are performed.
Medical NecessityRead more →
The insurer is reviewing whether the service is clinically appropriate for your situation.
Important: AuraCode is an educational tool. It does not provide medical, legal, or insurance advice, claims decisions, or approval guarantees. Final coverage depends on your specific plan, eligibility, diagnosis, submitted documentation, and your insurer's review.