Page 109 - Medicare Benefit Policy Manual

• Policies for physical therapy, occupational therapy, and speech-language
pathology services are in sections 220 and 230 of this chapter and in Pub. 100-04,
chapter 5, sections 10 and 20.

• Policies for services furnished incident to physicians’ services in the physician’s
office are in section 60 of this chapter.

• Policies for therapeutic services furnished incident to physicians’ services in the
hospital outpatient setting are in chapter 6, section 20.5, of this manual.

• Policies for diagnostic tests in the physician’s office are in section 80 of this
chapter.

• Policies for diagnostic tests furnished in the hospital outpatient setting are in
chapter 6, section 20.4, of this manual.

Therapeutic or treatment services that are not audiology services and are not “always”
therapy (according to the policy in Pub.100-04, chapter 5, section 20) and are furnished
by audiologists may be billed incident to the services of a physician when all other
appropriate requirements are met.

In addition, the TC or facility services for diagnostic tests that are not audiology services
may be billed by physicians or hospital outpatient departments when provided by qualified
personnel (who may be audiologists), and physicians and hospital outpatient departments
may bill for these diagnostic tests when provided by those qualified personnel under the
specified level of physician supervision for the diagnostic test.

80.3.1 - Definition of Qualified Audiologist
(Rev. 84; Issued: 02-29-08; Effective: 04-01-08; Implementation: 04-07-08)

Audiological tests require the skills of an audiologist and shall be furnished by qualified
audiologists, or, in States where it is allowed by State and local laws, by a physician or
non-physician practitioner. Medicare is not authorized to pay for these services when
performed by audiological aides, assistants, technicians, or others who do not meet the
qualifications below. In cases where it is not clear, the MAC shall determine whether a
service is an audiological service that requires the skills of an audiologist and whether the
qualifications for an audiologist have been met.

Section 1861(ll)(3) of the Act, provides that a qualified audiologist is an individual with a
th
master’s or doctoral degree in audiology. Therefore, a Doctor of Audiology (AuD) 4
year student with a provisional license from a State does not qualify unless he or she also
holds a master’s or doctoral degree in audiology. In addition, a qualified audiologist is an
individual who: