Part B Insider (Multispecialty) Coding Alert
Meet These Requirements to Qualify As An Independent Audiologist
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Starting Oct. 1, audiologists must be licensed in states that offer licensing Question:
Answer: For your filling-in audiologist to report diagnostic tests using her own national provider identification (NPI), she will have to obtain her license. While CMS Transmittal 84 revised the definition of a qualified audiologist to an individual who has obtained her master's or doctoral degree in audiology (invalidating a 4th year audiology student), the individual must also hold a license in states that offer licensing.
If the temporary audiologist obtains her license and you obtain her NPI and personal identification number (PIN, for Medicare enrollment) and have benefits assigned to your group (using the 855R), you would report audiological diagnostic tests (such as 92552-92557, 92561-92585, 92587-92588 or 92596) she performs directly under her NPI and direct supervision would not be required. Medicare will pay covered services that a qualified audiologist performs and bills directly at 100 percent of the fee schedule.
Until the audiologist obtains her state license, Medicare will not consider her a qualified audiologist. Starting Oct. 1, you will have to consider her a technician and bill her services incident-to the supervising physician, provided her services meet technician requirements. To cover technician-performed audiological testing, the encounter must meet these criteria:
• The doctor will have to order the test using the specific CPT code, provide direct supervision, document his clinical decision-making and active role in the testing, and provide the interpretation.
• The technician must sign her name and title on all performed tests and can provide only tests that your carrier determines do not require an audiologist's skill.
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