Hearing Screening and Audiologist Services

COVERAGE

Coverage Statement: Hearing screening and audiologist services are covered when Medicare coverage criteria are met.

Guidelines/Notes:

1. Hearing screening services are covered when performed in the physician's office Note: These may include use of an office screening audiometer, tuning fork, or whispered number recognition. Medicare considers these services incident to a physician’s office visit.

2. Audiology Services Hearing and balance assessment services are termed “audiology services,” regardless of whether they are furnished by an audiologist, physician, nonphysician practitioner (NPP), or hospital.

Examples of appropriate reasons for ordering audiological diagnostic tests that could be covered include, but are not limited to:

 Evaluation of suspected change in hearing, tinnitus, or balance;

 Evaluation of the cause of disorders of hearing, tinnitus, or balance;

 Determination of the effect of medication, surgery, or other treatment;

 Reevaluation to follow-up changes in hearing, tinnitus, or balance that may be caused by established diagnoses that place the patient at probable risk for a change in status including, but not limited to: otosclerosis, atelectatic tympanic membrane, tympanosclerosis, cholesteatoma, resolving middle ear infection, Meniére’s disease, sudden idiopathic sensorineural hearing loss, autoimmune inner ear disease, acoustic neuroma, demyelinating diseases, ototoxicity secondary to medications, or genetic vascular and viral conditions;

 Failure of a screening test (although the screening test is not covered);

 Diagnostic analysis of cochlear or brainstem implant and programming; and

 Audiology diagnostic tests before and periodically after implantation of auditory prosthetic devices.

If a physician refers a beneficiary to an audiologist for testing related to signs or symptoms associated with hearing loss, balance disorder, tinnitus, ear disease, or ear injury, the audiologist’s diagnostic testing services should be covered even if the only outcome is the prescription of a hearing aid.

Notes:

 Audiological diagnostic services are not covered when the diagnostic information required to determine the appropriate medical or surgical treatment is already known to the physician, or the diagnostic services are performed only to determine the need for or the appropriate type of a hearing aid, unless member has a supplemental hearing aid benefit.)

 Audiological treatment is not covered. There is no provision in the law for Medicare to pay audiologists for therapeutic services. 

For example, vestibular treatment, auditory rehabilitation and auditory processing treatment, while they are within the scope of practice of audiologists, are not diagnostic tests, and therefore, shall not be billed by audiologists to Medicare or UnitedHealthcare. 

Services related to hearing aid evaluation and fitting are not covered regardless of how they are billed. However, diagnostic testing services of an audiologist are covered when performed under the order of a physician for the management and adjustment of a covered surgically implanted hearing device.

3. Computerized Dynamic Posturography (CDP)

 Medicare does not have a National Coverage Determination (NCD) for Computerized Dynamic Posturography (CDP).

 Local Coverage Determinations (LCDs) exist and compliance with these policies is required where applicable. See the LCD Availability Grid (Attachment A).

 For states with no LCDs, refer to the UnitedHealthcare Medical Policy for Computerized Dynamic Posturography. 

(IMPORTANT NOTE: After searching the Medicare Coverage Database, if no state LCD or Local Article is found, then use the above referenced policy.)

 Committee approval date: July 26, 2016

 Accessed October 21, 2016

4. Hearing examinations for the prescription, fitting or adjustment of standard hearing aids are not covered. 

DEFINITIONS

Audiological Diagnostic Testing: Tests of the audiological and vestibular systems, e.g., hearing, balance, auditory processing, tinnitus and diagnostic programming of certain prosthetic devices, performed by qualified audiologists.

Qualified Audiologist: A qualified audiologist is an individual with a master’s or doctoral degree in audiology. Therefore, a Doctor of Audiology (AuD) 4th 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:

 Is licensed as an audiologist by the State in which the individual furnishes such services, or

 In the case of an individual who furnishes services in a State which does not license audiologists has:

o Successfully completed 350 clock hours of supervised clinical practicum (or is in the process of accumulating such supervised clinical experience), and

o Performed not less than 9 months of supervised full-time audiology services after obtaining a master’s or doctoral degree in audiology or a related field, and

o Successfully completed a national examination in audiology approved by the Secretary.

If it is necessary to determine whether a particular audiologist is qualified under the above definition, the carrier should check references. Carriers in States that have statutory licensure or certification should secure from the appropriate State agency a current listing of audiologists holding the required credentials. 

Additional references for determining an audiologist’s professional qualifications are the national directory published annually by the American SpeechLanguage Hearing Association and records and directories, which may be available from the State Licensing Authority.