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Is Physician Referral for Audiology Services Necessary?

Steven C. White, PhD, CCC-A

February 28, 2011


Question

Is it necessary for the physician to refer a patient specifically to the particular audiologist's office in a "referral" or is it fine for them to write a general script for services such hearing evaluation and/or hearing aids only?

Answer

Neither state licensure nor an audiologist's ethics require a referral but most, if not all, third party payers will require such. It is best to check with the particular payer regarding the specifics of the referral. However, payers are reasonable for the most part and allow a general referral as is the case for Medicare. Medicare permits a written document signed by the treating physician/practitioner or his/her office, a telephone call by the treating physician/practitioner or his/her office, or an electronic mail by the treating physician/practitioner or his/her office (section 80.6.1 of Chapter 15 of the Mediccare Benefit Policy Manual). Further, Medicare states, "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. For more information see Medicare Coverage of Audiological Diagnostic Testing at asha.org/practice/reimbursement/medicare/aud_services.htm.

Dr. Steven C. White has been an audiologist for over 40 years and at ASHA for 30years where he is the director of Health Care Economics and Advocacy. He can be contacted at swhite@asha.org.


steven c white

Steven C. White, PhD, CCC-A

Director of the Health Care Economics and Advocacy at the ASHA National Office.

Steven C. White, PhD, CCC-A, is the Director of the Health Care Economics and Advocacy at the ASHA National Office. White, an ASHA Fellow, is ex officio to the Health Care Economics Committee.  His responsibilities include Medicare, private health insurance and Medicaid especially coding and outpatient reimbursement policies as they relate to these payers.  White is the staff liaison to the American Medical Association Current Procedural Terminology Editorial Panel and the AMA Relative Value Update Committee.  He has published and presented extensively on third party reimbursement.  White is co-author with Janet McCarty of Health Plan Coding and Claims Guide (2005), Negotiating Health Care Contracts and Calculating Fees (2004), Appealing Health Plan Denials, and Getting Your Services Covered.  White is also coauthor with Ingrida Lusis and Mark Kander of the Medicare Handbook for Audiologists (2005).  White holds a PhD in audiology from Wayne State University and an MS in speech-language pathology and audiology from Ithaca College.


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