Medicare Audiology Billing Services

Clarifying Medicare Audiology Billing Services: Audiology and OTO-Techs

Recently, the Academy has received numerous questions from members on Medicare audiology billing and what services audiology/ otolaryngology-technicians (oto-techs) can bill. In response, resources on the Academy’s website have been developed to help to clarify this issue. (http://www.entnet.org/Practice/Medicareupdates.cfm#CP_JUMP_149730). A frequently asked question and answer is provided below, followed by a summary of information provided on our website.

This is meant to be a guide to assist with questions and not a definitive source. For a definitive list of what procedures audiology/ oto-tech’s can provide and bill, contact your Medicare Administrative Contractor because Medicare allows them to determine what services oto-techs can perform and the qualifications needed, based on state and/or local law. 

Q: What Services Can Oto-Techs Provide and Bill?

Answer: A physician orders a comprehensive audiometry threshold evaluation and speech recognition test (CPT 92557), but wonders if their certified audiology technician or oto-tech can perform and bill for this? In most states, the answer is no, they cannot. According to Medicare, audiology/oto-techs cannot bill Medicare for 92557 because there is no separate professional component (-26)/ technical component (TC) breakout where the technician would be able to bill for the TC. However, qualified professionals that have their own Medicare NPI, such as an Audiologist, may bill for this.

In June 2010, CMS released MedLearn Matters 6447, URL http://www.cms.gov/MLNMattersArticles/downloads/MM6447.pdf, which clarified the Medicare policy on billing for audiology services. CMS indicated that qualified technicians, including those trained in the Academy’s oto-tech program, can only perform diagnostic audiology tests (under direct physician supervision) that have a technical and professional component. In such cases, the technicians can only perform the technical component of the test. This revised policy took effect September 30, 2010. 

Tests that have a split professional and technical component (TC/ -26) most likely do not likely require an audiologist. The full list of Audiology codes can be found here, 

http://www.cms.gov/Medicare/Billing/TherapyServices/Downloads/Audiology_Codes.pdf. 

For codes that do have a split, an oto-tech (or other practitioners that furnishes the technical component) may perform the technical component of the service under direct physician supervision (note that for CPT codes with a split, the physician, non-physician practitioner or audiologist must perform the professional component of the tests). However, as mentioned previously, be sure to check with your local Medicare contractor for guidelines. 

The medical record must contain the name and professional identity of the technician who actually performed the service. The physician must order the audiological diagnostic testing specifically, listing each test individually. Again, check with your local Medicare contractor for guidelines.