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Medicare Frequently Asked Questions: Audiology

Physician Order/Referral

Does Medicare require physician orders before an audiologist can perform an evaluation?

 Chapter 15, §80.3, of the Medicare Benefit Policy Manual [PDF, 1.2MB] is clear on this subject. Medicare audiology coverage is part of the "other diagnostic tests" benefit and the performance of diagnostic tests requires an order from a physician, or, where allowed by State and local law, by a non-physician practitioner (NPP) as well as medical necessity. Under Medicare, a NPP is a physician assistant, nurse practitioner, or clinical nurse specialist. The tests are not covered if the physician/NPP order is obtained after the tests are performed. For further information, visit the Centers for Medicare and Medicaid Services (CMS) Audiology Services Web site. Please note, that the existence of a physician order does not guarantee that the threshold for medical necessity has been met. The diagnostic testing is only reimbursed by Medicare if it is reasonable and necessary.

Is the physician's signed order required in the patient's medical record?

No signature is required. An e-mail or telephone call by the treating physician/NPP or his/her office to the testing site is sufficient if the physician/office and the testing site document the communication in their respective copies of the beneficiary's medical records.

The Medicare Beneficiary Manual, Chapter 15, §80.6.1 [PDF, 1.2MB] states:

Order. An "order" is a communication from the treating physician/practitioner requesting that a diagnostic test be performed for a beneficiary. The order may conditionally request an additional diagnostic test for a particular beneficiary if the result of the initial diagnostic test ordered yields to a certain value determined by the treating physician/practitioner (e.g., if test X is negative, then perform test Y). An order may be delivered via the following forms of communication:

  • A written document signed by the treating physician/practitioner, which is hand-delivered, mailed, or faxed to the testing facility; Note: No signature is required on orders for clinical diagnostic tests paid on the basis of the clinical laboratory fee schedule, the physician fee schedule, or for physician pathology services;
  • A telephone call by the treating physician/practitioner or his/her office to the testing facility; and
  • An electronic mail by the treating physician/practitioner or his/her office to the testing facility.

If the order is communicated via telephone, both the treating physician/practitioner or his/her office, and the testing facility must document the telephone call in their respective copies of the beneficiary's medical records. While a physician order is not required to be signed, the physician must clearly document, in the medical record, his or her intent that the test be performed. 

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