ABR and ENG Reimbursement

Question

Answer

If the payer is Medicare, then you can bill only the technical component of the procedure. However, for private payers not related to Medicare, there are many audiologists who bill the global fee. Does that mean you will be reimbursed the global fee in contrast to just the technical component? It depends on the insurer. We do not perform ENGs where I am, but we do perform auditory evoked potential test procedures. In our practice, we typically bill the global fee when it is a private insurer. I would recommend checking with your contract agreement with the third party payer. If there is nothing in the contract that specifies technical component billing only, then it should be your decision whether to bill the global fee or the technical component. But remember, for Medicare you must bill only the technical component. For Medicaid, the rules vary considerably from state to state. Because of that, you will need to contact your local or state Medicaid office to determine whether Medicaid will reimburse an audiologist for ENG testing and whether there are any billing restrictions.

Bob Fifer

Robert C. Fifer, Ph.D.
Director of Audiology and Speech-Language Pathology
Mailman Center for Child Development
1601 NW 12th Avenue
Miami, FL 33101