Medicare Reimbursement of Audiology Services
Audiology services under Medicare Part B have reimbursement rates established by the Medicare Physician Fee Schedule (MPFS) regardless of provider setting, except for those services provided to hospital outpatients under the Hospital Outpatient Prospective Payment System (HOPPS). Payment is determined by the fee associated with a specific procedure code in those settings. The fee schedule and HOPPS are updated annually.
Coding
- Medicare Coding Rules: Audiology
- National Correct Coding Initiative (CCI) Edits and Medically Unlikely Edits (MUEs)
- Coding for Reimbursement
- Coding Systems
Billing
- Medicare Billing of Audiology Services
- CMS 1500 Health Insurance Claim Form [PDF] - Sample only
- Step-by-step instructions for the CMS 1500 form [PDF]
- Health Insurance Portability & Accountability Act (HIPAA)
Fraud and Abuse
- Issues in Ethics Statement: Reimbursement
- Summary of Self-Referral (Stark Law) and Anti-Kickback Regulations
- Self-Referral (Stark Law) and Anti-Kickback Regulations: Q & A
- CMS Physician Self-Referral Information
Other Resources
- ASHA's State Advocates for Medicare Policy (StAMP) (a State-Based Advocacy Network)
- CMS Medicare Physician Fee Schedule Look Up
- CMS webpage on Electronic Billing & EDI Transactions
See also: Medicare Coverage Policies
