Page 104 - Medicare Benefit Policy Manual

Herein after in this section, hearing and balance assessment services are termed
“audiology services,” regardless of whether they are furnished by an audiologist,
physician, nonphysician practitioner (NPP), or hospital.

Because audiology services are diagnostic tests, when furnished by a physician in an
office or hospital outpatient department, they must be furnished under the appropriate
level of supervision of a physician as established in 42 CFR 410.32(b)(1) and 410.28(e).
However, as specified in 42 CFR 410.32(b)(2)(ii) or (v), respectively, they are excepted
from physician supervision when they are personally furnished by a qualified audiologist
or performed by a nurse practitioner or clinical nurse specialist authorized to perform the
tests under applicable State laws.

Audiological diagnostic testing refers to tests of the audiological and vestibular systems,
e.g., hearing, balance, auditory processing, tinnitus and diagnostic programming of
certain prosthetic devices, performed by qualified audiologists.

Audiological diagnostic tests are not covered under the benefit for services incident to a
physician’s service (described in Pub. 100-02, chapter 15, section 60), because they have
their own benefit as “other diagnostic tests”. See Pub. 100-04, chapter 13 for general
diagnostic test policies.

Audiology services, like all other services, should be reported under the most specific
HCPCS code that describes the service that was furnished and in accordance with all CPT
guidance and Medicare national and MAC instructions.

B. Orders.

Audiology tests are covered as “other diagnostic tests” under section 1861(s)(3) or
1861(s)(2)(C) of the Act in the physician’s office or hospital outpatient settings,
respectively, when a physician (or an NPP, as applicable) orders such testing for the
purpose of obtaining information necessary for the physician’s diagnostic medical
evaluation or to determine the appropriate medical or surgical treatment of a hearing
deficit or related medical problem. See section 80.6 of this chapter for policies regarding
the ordering of diagnostic tests.

If a beneficiary undergoes diagnostic testing performed by an audiologist without a
physician order, the tests are not covered even if the audiologist discovers a pathologic
condition.

When a qualified physician orders a qualified technician (see definition in subsection D
of this section) to furnish an appropriate audiology service, that order must specify which
test is to be furnished by the technician under the direct supervision of a physician. Only
that test may be provided on that order by the technician.