Payment for the facility resources (including the TC of PC/TC split codes) of audiology services
provided to Part A inpatients of SNFs is included in the PPS rate. For SNFs, if the beneficiary
has Part B but not Part A coverage (e.g., Part A benefits are exhausted), the SNF may elect to
bill for audiology services but is not required to do so. Since audiology services furnished during a noncovered SNF stay are not bundled
with speech-language pathology services, payment can be made either to the SNF or to the
audiology service provider/supplier.
Audiologists, physicians, and NPPs enrolled in Medicare may bill directly for services rendered
to Medicare beneficiaries who are in a SNF stay that is not covered by Part A but who have Part
B eligibility. Payment is made based on the MPFS, whether on an institutional or professional
claim. For beneficiaries in a noncovered SNF stay, audiology services are payable under Part B
when billed by the SNF on an institutional claim as type of bill 22X, or when billed directly by
the provider or supplier of the service (the audiologist, physician, or NPP who personally furnishes the test) on a professional claim. For PC/TC split codes, the SNF may elect to bill for
the TC of the test on an institutional claim but is not required to bill for the service.
Implant Processing
Payment for diagnostic testing of implants, such as cochlear, osseointegrated or brainstem
implants, including programming or reprogramming following implantation surgery is not
included in the global fee for the surgery.
The diagnostic analysis of a cochlear implant shall be billed using CPT codes 92601 through
92604.
