If your audiologist is credentialed with Medicare, then you can bill the audiogram solely under the audiologist. Otherwise, the audiogram should be billed with the audiologist as the provider of service and the doctor as the non-billing provider. Here is the explanation from the Medicare Manual.
Full Answer
How do you Bill an audiologist for a Medicare claim?
The National Provider Identifier (NPI) and name of the physician ordering the audiology evaluation must be included on the claim form. Audiologists who provide diagnostic testing for the hearing and vestibular systems to Medicare beneficiaries must bill Medicare directly for their services.
Can an audiologist bill Medicare for SNF?
Audiologists, physicians, and NPPs enrolled in Medicare may bill directly for services rendered to Medicare beneficiaries who are in a SNF stay that is not covered by Part A but who have Part B eligibility. Payment is made based on the MPFS, whether on an institutional or professional claim.
How is Medicare Part B audiology coverage determined?
Coverage for audiology services is determined by the reason the tests are ordered, rather than by the patient’s diagnosis or condition. Medicare Part B provides payment for many types of services and procedures. The Medicare Administrative Contractor (MAC) that pays your claims is the best source for answers to specific Medicare billing questions.
What are the Medicare rules for student audiologist evaluations?
According to Medicare rules, when a Medicare beneficiary is being evaluated by a student they must be 100% supervised by the licensed audiologist. For any services performed by a student, the audiologist must be in the room, guiding the student, fully engaged in the evaluation, and not performing any other tasks.
Does Medicare cover an audiogram?
Medicare doesn't cover hearing exams, hearing aids, or exams for fitting hearing aids.
Can an audiologist bill Medicare?
Private practice audiologists can bill Medicare directly for diagnostic services. Audiology billing policies are found in the Medicare Claims Processing Manual at Chapter 12, Section 30.3 [PDF], which are pulled out here.
How do I bill for audiology?
Audiologists billing 92567 and 92568 on the same day should use 92550. Bill the individual CPT code if you do not performing both tests on the same day. CCI edits do not allow billing of 92552, 92553, 92555, or 92556 on the same day as 92557 because they are components of comprehensive audiometry.
Does Medicare pay for CPT 92557?
CPT® code 92557 will also be covered if ordered and performed in conjunction with Vestibular Function Testing (VFT), instead of CPT® code 92553, when the speech recognition component of the CPT® code 92557 is reasonable and necessary in the diagnosis or treatment of an individual Medicare beneficiary (e.g., Vestibular ...
Can audiologists Bill E M codes?
Medicare, therefore, does not allow audiologists, SLPs, and most other nonphysician specialists—except nurse practitioners, clinical nurse specialists, certified nurse midwives and physician assistants—to use E/M codes.
What is the CPT code for hearing test?
As indicated in the Current Procedural Terminology (CPT) manual, the Audiologic Function Tests (Codes 92550 through 92700) include the testing of both ears. If only one ear instead of two ears is tested, the -52 modifier (Reduced Services) should be utilized.
What does CPT modifier 52 mean?
Modifier -52 identifies that the service or procedure has been partially reduced or eliminated at the physician's discretion. The basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Can an audiologist Bill 99211?
Code 99211 (office or other outpatient visit for the evaluation of management of an established patient) does not require a physician to be present. That is a code that, within the code description, is allowed for use by an audiologist. This code does not have components of a case history.
Does 99173 require a modifier?
99173 with an E/M service When billing for a separately identifiable service on the same date as an E/M service, the modifier −25 should be appended to the E/M code (for instance, 99213-25.) Payers may choose to bundle code 99173 with the E/M service despite the correct modifier usage.
What is included in CPT code 92557?
Comprehensive audiometric evaluation (air, bone and speech) is reported using CPT code 92557.
How do I bill CPT 99358?
The codes follow CPT time rules. The physician, NP, or PA must spend more than half of the required one hour to report the codes. So, for example, you would bill 99358 for visits of 30-74 minutes. But you would bill 99358 and +99359 for a visit of 75 minutes or more, with +99359 for each additional 30-minute increment.
Can 99356 be billed alone?
When you realize that you need to spend significantly more time than usual with a patient, start watching the clock and keeping track of how long the service takes. To bill a 99356 alone or with a 99357, the time spent with the patient does not have to be continuous.
What is an audiology service?
As defined in the Social Security Act, section 1861 , (ll) (3), the term “audiology services” specifically means hearing and balance assessment services furnished by a qualified audiologist. Hearing and balance assessment services are termed “audiology services” regardless of whether they are furnished by an audiologist, physician, nonphysician practitioner (NPP), or hospital.
Who furnishes audiology?
Audiology services must be personally furnished by an audiologist, or nonphysician practitioner (NPP). Physicians may personally furnish audiology services, and technicians or other qualified staff may furnish those parts of a service that do not require professional skills under the direct supervision of physicians.
Does Medicare pay for audiology?
There is no provision in the law for Medicare to pay audiologists for therapeutic services. Audiological diagnostic tests are not covered under the benefit for services incident to a physician's service (described in Pub. 100-02, chapter 15, section 60), because they have their own benefit as “other diagnostic tests”.
Do you need an order for an audiology exam?
Orders are required for audiology services in all settings. Coverage and, therefore, payment for audiological diagnostic tests is determined by the reason the tests were performed, rather than by the diagnosis or the patient's condition.
Is audiology covered by Social Security?
Audiology services are generally covered as “other diagnostic tests” under section 1861 (s) (3) of the Social Security Act and payable under the Physician Fee Schedule (PFS). Audiology services furnished to an outpatient of a hospital are covered as “diagnostic services” under section 1861 (s) (2) (C) and payable under the hospital Outpatient Prospective Payment System (OPPS). View the list of audiology services HCPCS codes (PDF) .
How often are CPT codes billed?
Most CPT/HCPCS codes reported by audiologists are untimed and do not include time designations in the code descriptor. An untimed code is billed once per day, regardless of the time spent providing the service. On the other hand, timed codes include a time designation in the descriptor (for example, "per hour," "first hour," "initial 15 minutes," "each additional 30 minutes") and may be billed multiple times per day to represent the amount of time spent in direct patient care. Bill a timed code only when face-to-face time spent in an evaluation is at least 51% of the time designated in the code's descriptor.
What is modifier 59?
Modifier -59 is used to establish one procedure as distinct from another procedure billed on the same day, but should only be used based on instruction from the payer. Medicare publishes National Correct Coding Initiative (CC) edits that may require modifier -59.
What is the basic vestibular evaluation?
Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording. (Do not report in conjunction with 92541, 92542, 92544, or 92545)
What is a CPT assistant?
CPT Assistant references are American Medical Association policies for coding best practice. Audiologists should also verify payment rules with their local Medicare Administrative Contractor and review ASHA's annual analysis of the Medicare Physician Fee Schedule for Medicare Part B policy changes and national payment rates.
How many positions are required for a positional nystagmus test?
Positional nystagmus test, minimum of 4 positions, with recording. (Do not report 92542 in conjunction with 92540 or the set of 92541, 92544, and 92545)
When was CPT 92570 removed?
Deleted in 2010. Audiologists should use CPT 92570, since acoustic reflex decay testing is always done in conjunction with tympanometry and acoustic reflex threshold testing.
Why is modifier -22 not used?
Modifier -22 shouldn't be used frequently because the Medicare contractor could determine that the procedure reflects typical service delivery. Claims with the -22 modifier require an additional description of the need for extended services. Modifiers -22 and -52 may not be used in conjunction with timed codes.
How many hours of supervised clinical practicum for audiology?
successfully completed or is in the process of accumulating 350 clock hours of supervised clinical practicum, performed not less than 9 months of supervised full-time audiology services after obtaining a master's or doctoral degree in audiology, successfully completed a national examination in audiology approved by the Secretary.
What is Medicare benefit policy manual?
The Medicare Benefit Policy Manual at Chapter 15, Section 80.3 [PDF], defines the audiology benefit, qualifications, and other policy criteria necessary for audiologists providing services to Medicare beneficiaries.
What is an AUD license?
A doctor of audiology ( AuD) 4th-year student with a provisional license from a state does not qualify unless he or she also holds a master's or doctoral degree in audiology. Technicians, auxiliary personnel, hearing instrument specialists, and students of audiology performing audiologic assessments must have direct physician supervision. Direct supervision requires the physician to be on site and immediately available, but does not require the physician's presence in the room when the procedure is performed. According to Medicare rules, when a Medicare beneficiary is being evaluated by a student they must be 100% supervised by the licensed audiologist. For any services performed by a student, the audiologist must be in the room, guiding the student, fully engaged in the evaluation, and not performing any other tasks. The documentation must be signed by the audiologist, and the services are the full responsibility of the audiologist.
What is a reevaluation of hearing?
reevaluation to follow up regarding changes in hearing, tinnitus, or balance that may be caused by established diagnoses that place the patient at probable risk for a change in status, including but not limited to otosclerosis, atelectatic tympanic membrane, tympanosclerosis, cholesteatoma, resolving middle ear infection, Meniére's disease, sudden idiopathic sensorineural hearing loss, autoimmune inner ear disease, acoustic neuroma, demyelinating diseases, ototoxicity secondary to medications, or genetic vascular and viral conditions;
What is a hearing evaluation?
evaluation of the cause of disorders of hearing, tinnitus, or balance; evaluation of suspected change in hearing, tinnitus, or balance; determination of the effect of medication, surgery, or other treatment; reevaluation to follow up regarding changes in hearing, tinnitus, or balance that may be caused by established diagnoses ...
Does Medicare cover audiologist testing?
Medicare Coverage of Audiologic Diagnostic Testing. Medicare covers audiologic diagnostic testing provided by an audiologist when a physician or non-physician practitioner (nurse practitioner, clinical nurse specialist, or physician’s assistant) orders the evaluation for the purpose of informing the physician's diagnostic medical evaluation ...
Do you need a physician order for audiology?
A physician order is required prior to the provision of audiology services . If a beneficiary undergoes diagnostic testing performed by an audiologist without a physician order, the tests are not covered, even if the audiologist discovers a pathologic condition.
What are the specific requirements when performing and billing for otoacoustic emissions (OAEs)?
Otoacoustic emissions are not warranted in every test scenario. The documentation must substantiate the need for service.
What code can I use to bill for speech-in-noise testing (e.g. QuickSIN, HINT, BKB-SIN)?
Alternatively, it could be billed as an unlisted otorhinolaryngological procedure code 92700, with documentation & explanation of the procedure. Audiologists should consult payer guidelines for submitting the unlisted code.
What is an ICD code?
The International Classification of Diseases (ICD) codes are numeric or alpha-numeric codes that are used to classify a diagnosis. The ICD-CM (Clinical Modification) is the version of ICD that is used in the United States.
How do I indicate that I performed only unilateral testing?
As indicated in the Current Procedural Terminology (CPT) manual, the Audiologic Function Tests (Codes 92550 through 92700) include the testing of both ears. If only one ear instead of two ears is tested, the -52 modifier (Reduced Services) should be utilized.
What CPT code should I use to report vestibular evoked myogenic potentials (VEMPs)?
The billing codes changed effective January 1, 2021, so the joint guidance developed by ADA, ASHA, and the Academy for this question is no longer current information. For updated information on billing for VEMPs, please refer to the following January/February Audiology Today article.
What is the code for bilateral cochlear implants?
In these circumstances, where bilateral cochlear implants are fit and managed, we recommend that a -22 modifier (Unusual procedural service) be added to the applicable code of 92601-92604 and that the necessary documentation be submitted with the claim. This documentation should outline what differentiates a singular cochlear implant fitting/remapping from a bilateral cochlear implant fitting/remapping and it should address any additional time, equipment, staffing, etc. required. Some payors may require the RT modifier to indicate the right ear and the LT modifier to indicate the left ear when there are bilateral cochlear implants.
What is the CPT code for ENG?
This add-on code has historically been utilized for the use of electrodes when performing electronystagmography (ENG). CPT code 92547 should be utilized for ENG only.
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Who pays for audiology on Medicare?
Audiologists, physicians, and NPPs enrolled in Medicare may bill directly for services rendered to Medicare beneficiaries who are in a SNF stay that is not covered by Part A but who have Part B eligibility. Payment is made based on the MPFS, whether on an institutional or professional claim. For beneficiaries in a noncovered SNF stay, audiology services are payable under Part B when billed by the SNF on an institutional claim as type of bill 22X, or when billed directly by the provider or supplier of the service (the audiologist, physician, or NPP who personally furnishes the test) on a professional claim. For PC/TC split codes, the SNF may elect to bill for the TC of the test on an institutional claim but is not required to bill for the service.
Who can bill for audiology?
Audiology codes may be billed under the MPFS by audiologists, physicians, and NPPs using their own NPI in the rendering loop when those professionals personally furnish the test. Physicians and NPPs may not bill for these codes when an audiologist has furnished the service.
What is the interaction of these knowledge bases required to attain the clinical expertise for audiology tests?
The interactions of these knowledge bases are required to attain the clinical expertise for audiology tests. Also required are skills to administer valid and reliable tests safely, especially when they involve stimulating the auditory nerve and testing complex brain functions.
What skills are required for audiology?
The skills required when professionals furnish audiology services for payment under the MPFS are masters or doctoral level skills that involve clinical judgment or assessment and specialized knowledge and ability including, but not limited to, knowledge of anatomy and physiology, neurology, psychology, physics, psychometrics, and interpersonal communication. The interactions of these knowledge bases are required to attain the clinical expertise for audiology tests. Also required are skills to administer valid and reliable tests safely, especially when they involve stimulating the auditory nerve and testing complex brain functions.
What is CPT code 92700?
d.Tests that are Not Described by Specific CPT Codes. Tests that have no appropriate CPT code may be reported under CPT code 92700 (Unlisted otorhinolaryngological service or procedure).
What is the policy of audiology?
Policy Definition. Audiology is the study of hearing and hearing disorders and includes habilitation and rehabilitation for individuals who have hearing loss.
Who interprets audiology reports?
The interpretation and report shall be written in the medical record by the audiologist, physician, or NPP who personally furnished any audiology service, or by the physician who supervised the service. Technicians shall not interpret audiology services, but may record objective test results of those services they may furnish under direct physician supervision. Payment for the interpretation and report of the services is included in payment for all audiology services, and specifically in the professional component if the audiology service has a professional component/technical component split.
Question
I understand Medicare does not reimburse for an audiogram unless it is part of a medical evaluation referred by a physician. However, what if during a hearing aid check it is apparent there is a decrease in hearing that requires further testing and medical intervention.
Answer
Medicare has a strict requirement of "medical necessity". In the case of the first scenario where it is apparent during a hearing aid check that hearing is worse, I would take it upon myself to call the physician of record, convey what you are seeing, and seek either a referral or his/her blessing to repeat the audiogram.
Designation of Time
- Most CPT/HCPCS codes reported by audiologists are untimed and do not include time designations in the code descriptor. An untimed code is billed once per day, regardless of the time spent providing the service. On the other hand, timedcodes include a time designation in the descriptor (for example, "per hour," "first hour," "initial 15 minutes," "e...
Code Modifiers
- Clinicians use code modifiers appended to CPT or HCPCS codes on a claim to provide additional information about the services provided. For example, untimed codes may include modifiers to represent atypical procedures. Untimed CPT codes represent the "typical" time it takes to complete a specific evaluation or treatment. For significantly atypical procedures, a -22 modifie…
Same-Day Billing Restrictions
- See Medicare's National Correct Coding Initiative (CCI) editsfor restrictions on certain CPT code pairs reported on the same day.
Laterality
- Unless specifically noted in the descriptor, audiology-related CPT codes represent bilateral testing. Include modifier -52 (reduced service) for unilateral testing. (Reference, CPT Assistant, June 2004, p. 10)
Codes with The Professional and Technical Component (Pc/Tc) Split
- Some audiology codes include a PC/TC split, meaning that payment for the code can be split based on who provided specific components of the service. The professional component (PC) reflects the portion of the procedure that involves the clincian's professional work (e.g., interpreting test results). The technical component (TC) reflects the portion of the procedure tha…
Additional Resources
- Medicare Payment for Outpatient Audiology and Speech-Language Pathology Services
- Providing Telehealth Services Under Medicare During the COVID-19 Pandemic
- National Correct Coding Initiative (NCCI) for Audiology and Speech-Language Pathology Services(CCI Edits and Medically Unlikely Edits)
- Medicare Part B Claims Checklist
Cpt Codes and Special Medicare Rules For Audiologists
- Table 1: Services and Procedures Covered Under the Audiology Benefit
The following table lists services and procedures covered under the audiology diagnostic benefit.