Page 107 - Medicare Benefit Policy Manual

of any relevant education and training that has been completed by the technician, which
shall be available in the records of the clinic or facility.

Depending on the qualifications determined by the MAC, individuals who are also
hearing instrument specialists, students of audiology, or other health care professionals
may furnish the labor for appropriate audiology services under direct physician
supervision when these services are billed by physicians or hospital outpatient
departments.

E. Documentation for Audiology Services.

1. Documentation for Orders (Reasons for Tests).

The reason for the test should be documented either on the order, on the audiological
evaluation report, or in the patient’s medical record. (See subsection C. of this section
concerning reasons for tests.)

2. Documenting skilled services. When the medical record is subject to medical review,
it is necessary that the record contains sufficient information so that the MAC may
determine that the service qualifies for payment. For example, documentation should
indicate that the test was ordered, that the reason for the test results in coverage, and that
the test was furnished to the patient by a qualified individual.

Records that support the appropriate provision of an audiological diagnostic test shall be
made available to the MAC on request.

F. Audiological Treatment.

There is no provision in the law for Medicare to pay audiologists for therapeutic services.
For example, vestibular treatment, auditory rehabilitation treatment, auditory processing
treatment, and canalith repositioning, while they are generally within the scope of
practice of audiologists, are not those hearing and balance assessment services that are
defined as audiology services in 1861(ll)(3) of the Social Security Act and, therefore,
shall not be billed by audiologists to Medicare. Services for the purpose of hearing aid
evaluation and fitting are not covered regardless of how they are billed. Services
identified as “always” therapy in Pub. 100-04, chapter 5, section 20 may not be billed by
hospitals, physicians, NPPs, or audiologists when provided by audiologists. (See also
Pub. 100-04, chapter 12, section 30.3.)

Treatment related to hearing may be covered under the speech-language pathology
benefit when the services are provided by speech-language pathologists. Treatment
related to balance (e.g., services described by “always therapy” codes 97001-97004,
97110, 97112, 97116, and 97750) may be covered under the physical therapy or
occupational therapy benefit when the services are provided by therapists or their
assistants, where appropriate. Covered therapy services incident to a physician’s service
must conform to policies in sections 60, 220, and 230 of this chapter. Audiological