Questions and Answers: Comprehensive Medicare Coverage of Audiology Services

ASHA believes that Medicare beneficiaries should have access to audiologists for both diagnostic and treatment services. Audiologists are educated, trained, and permitted to perform comprehensive services under their state licensure and ASHA certification.

Why is ASHA supporting expanding Medicare coverage of audiology services?

ASHA's members signified that one of the highest advocacy priorities for 2010 should be to promote improved public and private coverage policies and reimbursement rates for audiologists and speech-language pathologists across the age span. This would include preventive, diagnostic, habilitative and rehabilitative treatment services, and equipment. Direct access and a comprehensive Medicare audiologic reimbursement benefit to include both diagnostic and rehabilitative services are major aspects of this top advocacy priority.

Does ASHA continue to support direct access?

ASHA supports direct access. However, the current legislation would create an audiology benefit that would define audiology services as strictly diagnostic in nature. Therefore, ASHA is developing draft legislation that would provide comprehensive coverage of audiology services.

Will a comprehensive benefit lower reimbursement rates for audiology services under Medicare?

ASHA does not believe that reimbursement rates will decrease as a result of comprehensive coverage. Audiology procedures are now viewed as professional rather than technical services. A comprehensive benefit would solidify ASHA's stance that audiologists provide professional services to Medicare beneficiaries. Moreover, Medicare coverage of management services would increase the number of patients eligible to see an audiologist for services beyond those diagnostic in nature.

How will comprehensive coverage improve access for Medicare beneficiaries?

Audiologists who wish to provide services, such as auditory rehabilitation, to Medicare beneficiaries now use an Advance Beneficiary Notice (ABN) that indicates the service will not be covered by Medicare. ABNs are necessary for services that are normally covered by Medicare and auditory rehabilitation is covered when rendered by a speech-language pathologist. Most Medicare beneficiaries will seek the covered provider because of economic reasons, so one can expect that audiologists who choose the ABN approach can lose patients. However, this would not occur if comprehensive coverage of audiology services were in place.

What additional services would be covered under comprehensive coverage?

Audiologists would be able to provide professional evaluation and management services as well as provide treatment to Medicare beneficiaries.

Would I be required to become a Medicare provider if the proposed ASHA legislation passes?

The ASHA draft legislation would allow audiologists to opt-out of becoming Medicare providers if they chose to do so.

ASHA Contact:
Vic S. Gladstone
Chief Staff Officer for Audiology
E-mail: audiology@asha.org