Page 108 - Medicare Benefit Policy Manual

treatment provided under the benefits for physical therapy and speech-language
pathology services may also be personally provided and billed by physicians and NPPs
when the services are within their scope of practice and consistent with State and local
laws.

For example, aural rehabilitation and signed communication training may be payable
according to the benefit for speech-language pathology services or as speech-language
pathology services incident to a physician’s or NPP’s service. Treatment for balance
disorders may be payable according to the benefit for physical therapy services or as a
physical therapy service incident to the services of a physician or NPP. See the policies
in this chapter, sections 220 and 230, for details.

G. Assignment.

Nonhospital entities billing for the audiologist’s services may accept assignment under
the usual procedure or, if not accepting assignment, may charge the patient and submit a
nonassigned claim on their behalf.

H. Opt Out and Mandatory Claims Submissions.

The opt out law does not define “physician” or “practitioner” to include audiologists;
therefore, they may not opt out of Medicare and provide services under private contracts.
See section 40.4 of this chapter for details.

When a physician or supplier furnishes a service that is covered by Medicare, then it is
subject to the mandatory claim submission provisions of section 1848(g)(4) of the Social
Security Act. Therefore, if an audiologist charges or attempts to charge a beneficiary any
remuneration for a service that is covered by Medicare, then the audiologist must submit
a claim to Medicare.

I. Non-Audiology Services Furnished by Audiologists.

Audiologists may be qualified to furnish all or part of some diagnostic tests or treatments
that are not defined as audiology services under the MPFS, such as non-auditory evoked
potentials or cerumen removal. Audiologists may not bill Medicare for services that are
not audiology services according to Medicare’s definition (see list at:
www.cms.gov/therapyservices). However, the labor for the Technical Component (TC)
of certain other diagnostic tests or treatment services may qualify to be billed when
furnished by audiologists under physician supervision when all the appropriate policies
are followed.

When furnishing services that are not on the Medicare list of audiology services, the
audiologist may or may not be working within the scope of practice of an audiologist
according to State law. The audiologist furnishing the service must have the
qualifications that are ordinarily required of any person providing that service. Consult
the following policies for details: