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Audiology services

Audiology services are defined as hearing and balance assessment services furnished by a qualified audiologist legally authorized to perform under state law (or the state regulatory mechanism provided by state law), as would otherwise be covered if furnished by a physician. Audiological tests are covered and payable when performed by qualified audiologists.

A qualified audiologist is an individual with a master’s or doctoral degree in audiology who:

  • Is licensed as an audiologist by the state in which the individual furnishes such services, or
  • In the case of an individual who furnishes services in a state which does not license audiologists, has successfully:
  • Completed 350 clock hours of supervised clinical practicum (or is in the process of accumulating such supervised clinical experience), 
  • Performed not less than nine months of supervised full-time audiology services after obtaining a master’s or doctoral degree in audiology or a related field, and 
  • Successfully completed a national examination in audiology approved by the secretary.

Note: Audiologists and speech-language pathologists furnish separate services to hearing-impaired patients. 

Covered services for audiologists

  • Audiological diagnostic tests under the benefit for "other diagnostic tests." 
  • Diagnostic tests done by an audiologist and the orders do not name specific tests; the audiologist may select the appropriate battery of tests. 
  • Audiological evaluations, which include tests of tinnitus, auditory processing, and Osseointegrated devices. 
  • Audiological tests may be ordered for any patient when there is suspicion of impairment of the auditory systems, including tinnitus, auditory processing, or balance. 
  • Osseointegrated auditory implants are prosthetic devices under provisions of the applicable payment system. Payment may differ depending upon whether the device is furnished on an inpatient or outpatient basis, by a hospital subject to the outpatient prospective payment system, by a critical access hospital, by a physician’s clinic, or by a federally qualified health center.

We will consider payment for:

  • Global service when audiologists perform both the technical and professional components of services that have both components. 
  • Technical component of audiological tests when they perform only the technical component, and a physician or qualified non-physician practitioner provides the professional component of services that have both components. 
  • Timed codes 92620 and 92621 when billed for appropriately provided evaluation of auditory processing disorders. 
  • Appropriately provided auditory rehabilitation evaluation as a speech-language pathology benefit when furnished by a speech-language pathologist. 
  • Appropriately provided auditory rehabilitation evaluation as a diagnostic test benefit when furnished by an audiologist. 
  • Appropriately provided speech-language pathology services after implantation of auditory devices
  • Appropriately provided services of an audiologist for diagnostic evaluation of cochlear implants
  • Medicare will not include diagnostic analysis of implants, (such as cochlear, osseointegrated or brainstem implants, including programming or reprogramming following implantation) in the global fee for the surgery. 

Non-covered services for audiologists

  • Services documented as audiological services when they have been furnished through the use of computers that do not require the skills of an audiologist.
  • Computer-controlled hearing tests that are screening tests, which do not require the skilled services of an audiologist, are not covered or payable using codes for diagnostic audiological testing. 
  • Examples include, but are not limited to, otograms and pure tone or immittance screening devices that do not require the skills of an audiologist. 
  • Treatment services, including hearing aids. 
  • Audiological tests should not be ordered for the purpose of fitting or modifying a hearing aid.
  • Diagnostic audiological tests provided by technicians unless the order specifies each test individually. 
  • The technicians must meet the qualifications determined by the Medicare contractor being billed. At a minimum, this will include:
    • The qualifications requirements of state and/or local law and successful conclusion of a curriculum including both classroom training, and 
    • Supervised clinical experience administering the audiological service. 
  • Services that require the skills of an audiologist when furnished by a Doctor of Audiology fourth-year student who is not qualified according to Section 1861(ll)(3) of the Act. 
  • Audiological services incident to the service of a physician or non-physician practitioner. 
  • Technical component of audiological diagnostic tests performed by a qualified technician unless the medical record contains the name and professional identity of the technician who actually performed the service. The physician's or non-physician's supervisor who provides the direct supervision must have documented the clinical decision-making and active participation in delivery of the service. 
  • The timed code 92506 is one of the “always therapy” codes listed in the MCPM that must be furnished by a speech-language pathologist under the standards and conditions for speech-language pathology services. Audiologists may not be paid for these codes. 

Billing

Medicare regulations require that audiologist's bill only for diagnostic services. Any other service not considered a diagnostic service is not billable by an audiologist. 

For dates of service prior to July 1, 2023, payment for diagnostic and balance assessment services furnished by audiologists were required to have an order from physicians or NPPs who are treating the patient. While all services furnished by audiologists must be personally provided, audiologists do not need the supervision of a physician/NPP to do so.

Effective July 1, 2023, CMS is allowing an exception to the treating physician or NPP order requirement so audiologists can provide certain diagnostic tests for non-acute hearing conditions and diagnostic services related to implanted auditory prosthetic devices. These tests are on a finalized list of 36 CPT codes in Appendix A of MM13055. Services may be provided once every 12 months using modifier AB. Audiologist enrolled in Medicare must bill independently for the services rendered and must use their own National Provider Identifier (NPI) on the claims they submit.

Physicians may bill for audiology services not personally furnished when performed by an audiologist, or Non-Physician Practitioner (NPP) when authorized to perform the tests under applicable state laws.

The CMS website provides a list of all CPT codes for audiology services.

The opt out law does not define “physician” or “practitioner” to include audiologists; therefore, they may not opt out of Medicare and provide services under private contracts.

 

References