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The Centers for Medicare and Medicaid Services (CMS) released an update to audiology coverage policies in the online Medicare Benefit Policy Manual [PDF]. The transmittal provides significant clarifying language to the brief coverage description that has been in place since 1973. Specific examples of audiological diagnostic testing are expanded from hearing and balance to include "auditory processing, tinnitus, and diagnostic programming of certain prosthetic devices." The manual now specifically includes programming as an audiology diagnostic service. Diagnostic tests "before and periodically after implementation of auditory prosthetic devices are covered services."
Besides the provision of information necessary for the physician's diagnostic evaluation or treatment decisions, new examples of reasons for coverage are confirmation of a prior diagnosis, post-evaluation diagnoses, treatment provided after diagnosis, including hearing aids, and the type of evaluation or treatment the physician anticipates before the diagnostic test. Coverage can also be based on the manner of the patient's response to the test, such as comparison or consideration of the anatomical or physiological implications of test results or patient responsiveness to stimuli during the test.
Medicare now has instructions for re-evaluations conducted by audiologists. The schedule for re-evaluation is determined by the ordering physician to determine changes in hearing or evaluate appropriate medical or surgical treatment. Re-evaluation may be appropriate, even when the evaluation was recent. For the first time, the Benefit Policy Manual will state that "computer-administered hearing tests are not covered" because these tests have been determined by CMS as screening tests that do not require skilled services of an audiologist.
Although the revision states that "Audiological diagnostic tests are not covered as services incident to physician's services," an employed/contracted audiologist may have services billed through the physician practice and the requirements associated with incident to billing do not apply (i.e., physician need not be on premises; patient need not be seen by the physician, physician assistant, nurse practitioner, or clinical nurse specialists). Incident to physicians' services are services rendered by an employee or contractor of a physician and billed through the physician. As always, audiologists employed in physician practices can bill Medicare directly and assign payment to the employer.
Lastly, according to the Medicare definition of audiologist, "a Doctor of Audiology 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." ASHA is finalizing a complete analysis of the policy which will soon be posted on ASHA's Member Web site. For further information, please contact reimbursement@asha.org.
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