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.
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) .
There is no provision in Medicare law to pay audiologists for therapy services such as auditory rehabilitation (see Pub 100-02, chapter 15 (PDF), section 80.3) or hearing aids and auditory implants (see Pub 100-02, chapter 16 (PDF), section 100). Audiology services are not covered under the benefit for services “incident to” a physician’s service (see Pub 100-02, chapter 15 (PDF), section 60) because audiologists have their own Medicare benefit that allows them to bill for audiology services they personally furnish.
A physician order is required for audiology services in all settings. 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. Find your MAC's website.If you have difficulty communicating with your contractor, use the CMS Regional Offices' web page to identify the CMS Regional Office that services your area of operations and use the email address to request assistance.