Audiologic Tests

Audiologic tests will generally be billed to the carrier by the provider of service. For tests that include both a professional component and technical component, the SNF may elect to bill the technical component to the intermediary, but is not required to bill the service. 

Payment to SNFs for audiologic tests are bundled into the PPS payment amount for beneficiaries in a covered SNF Part A stay, whether provided directly by the SNF or under arrangements by an independent provider based on a contract with the SNF. Independent audiologists may bill the carrier directly for services rendered to beneficiaries not in a SNF Part A covered stay. For beneficiaries not in a covered Part A SNF stay, who are sometimes referred to as beneficiaries in a Part B SNF stay, audiologic tests are payable under Part B when billed by the SNF as type of bill 22X, or when billed directly to the carrier by the provider of the service. Payment is based on the Medicare Physician Fee Schedule (MPFS), whether by the carrier or the intermediary.

Since audiologic tests are not bundled with speech -language pathology services, payment is made to the provider of service or to the SNF where the services are provided under arrangements with the SNF for SNF outpatients.

Billing Part B Radiology Services and Other Diagnostic Procedures 

Acceptable HCPCS codes for radiology and other diagnostic services are taken primarily from the CPT-4 portion of HCPCS. Payment is the lower of billed charges or the fee schedule amount. In either case, any applicable deductible and coinsurance amounts are subtracted from the payment amount prior to payment. Coinsurance is calculated on the Medicare payment amount after the subtraction of any applicable deductible amount.

• Contrast material other than low osmolar contrast material (LOCM) for radiology; 

• LOCM;

• Radiopharmaceuticals; 

• IV Persantine;

• Transportation of equipment; 

• Position Emission Tomography (PET); and 

• Adenosine.

Bone Mass Measurements

Sections 1861(s)(15) and §1861(rr)(1) of the Act (as added by §4106 of the Balanced Budget Act (BBA) of 1997) standardized Medicare coverage of medically necessary bone mass measurements by providing for uniform coverage under Medicare Part B.