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Otolaryngology Coding Alert

Reader Question:

Hearing Exam Providers, Beware: Facility Bills 92506

Published on Fri Jul 02, 2004

Question: I am a state-licensed audiologist in California. A primary-care physician requested that I evaluate the hearing of a skilled nursing facility (SNF) patient. Why did MediCal and Medicare deny service payment stating the claim is not medically necessary? California Subscriber Answer: Medicare and MediCal are probably denying the tests because the SNF is under Part A coverage. In a Part A setting, the SNF submits 92506 (Evaluation of speech, language, voice, communication, auditory processing, and/or aural rehabilitation status). You must contract with the SNF to receive hearing evaluation payment. If, however, the SNF falls under Part B coverage -- either because the patient exhausted his Part A benefits or didn't qualify for Part A coverage -- you should appeal the denials. For more on Medicare's audiologic function test rules in SNFs, visit www.audiology.org/about/newsroom/20010507.php.
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