Medicare stipulates that a physician's referral is required for audiologic testing in order for payment to be made to audiologist. What does that ''referral'' need to say? Can the request be simply ''Hearing evaluation'' or ''For the evaluation of hearing loss''? Does the physician need to be more specific?
Answer
The Medicare Carriers Manual stipulates the following in Section 2070.3: services are ''paid for when a physician orders testing to obtain information as part of his/her diagnostic evaluation, or to determine the appropriate medical or surgical treatment of a hearing deficit or related medical problem''
Medicare expects that the physician be as clear as possible in the referral and indicate that the patient requires further evaluation consistent with the above statement from the Carriers Manual. Medicare does not pay for hearing evaluations when the physician knows that the best treatment for the hearing loss is a hearing aid. The physician should indicate if there is something remarkable about the hearing loss or a if there is a complaint of tinnitus, dizziness, vertigo or other associated symptom. For more information see https://www.asha.org/practice/reimbursement/medicare/aud_services.htm.
Steven C. White, PhD Director Health Care Economics and Advocacy American Speech-Language-Hearing Association 10801 Rockville Pike Rockville, MD 20852 phone 301-897-0126 fax 301-897-7356 email swhite@asha.org https://www.asha.org/
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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