Otolaryngology Coding Alert

Question: Will Medicare pay for the technical component of diagnostic tests that are not on CMS’ list of audiology services when an audiologist administers those tests? I don’t see a mention of this in the claims manual.

Louisiana Subscriber

Answer: Chapter 12 of the Medicare Claims Processing Manual offers some useful insights into the world of audiology coding and billing, but the buck doesn’t stop there. If you’re looking for even more guidance geared toward the audiology specialty, you should look no further than the MLN Matters article #MM6447.

There may be an instance where an audiologist performs a service that’s not found on the Centers for Medicare & Medicaid Services (CMS) list of audiology services. In these cases, CMS will still pay for the technical component (TC) of diagnostic tests when audiologists furnish the tests as long as they are “under the designated level of physician supervision for the service and the audiologist is qualified to perform the service.”

While these instances may not be commonplace, you should be familiar with how to report them. Additionally, your audiologists and physicians should be aware that the possibility of billing out for such services exists as long as the guidelines are followed.

You can find a complete code list of audiology services here: www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ PhysicianFeeSched/Audiology.html.