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Audiology Coding

  1. #1
    Greensboro, NC
    Default Audiology Coding
    Medical Coding Books
    According to the policy from CMS on audiology services, it states that you cannot bill incident to for an audiologist effective April 7 2008. I am looking for more clarification. Is this for an audiologist working on their own, or for an audiologist working for a physician in his office? Is there a difference other than an audiologist can have their own practice and not work under the supervision of a physician. The revised policy came out on Feb 29th, if this is correct, all audiologists must have an NPI and to see Medicare patients must be a non participating provider or complete the application to become a participating provider. Anyone with more information, please respond.

  2. #2
    Stuart Sailfish Chapter
    This is one of those HUGE issues that alot of ENTs are battling right now. I spoke with the AAO-HNS and yes this is true. I have a call into our local Medicare carrier and am waiting a response.

    Our Audiologists do not have NPI's or Medicare PTANS.
    Candice Fenildo, CPC, CPMA, CPC-I, CPB, CENTC, CRHC, AAPC Fellow
    Director of Operations
    Ear, Nose and Throat Associates of South Florida, PA

    "Nothing is stronger than the heart of a volunteer"

  3. Default
    Hi Candice,

    Our office is trying to find answers to this question also. The academy tells us they are looking into it and our LMC is stating nothing has changed with audilogists in a physicians practice billing incident to.

    If anyone finds out anything different I would appreciate any additional facts.



  4. #4
    Jacksonville, Florida - 90417
    Default Audiology Coding
    Hi all,

    Diagnostic tests, including audiological tests, have their own benefit category under Medicare. As such, the incident to rules do not apply. What this means is that when a physician orders the test, and the audiologist performs the test, the service is billed under the physician's provider number. Just like you would if a physician ordered an in-office chest x-ray and it was performed by a radiology technician. As far as physician supervision is concerned though, the physician does not have to be in the office suite when the audiologist performs the service because the incident to rules do not apply and diagnostic tests furnished by an audiologist are an exception to the physician supervision rules for diagnostic x-ray and other diagnostic tests outlined in 42 CFR 410.32 (b).

    Hope this helps.

    Best Regards,

    Maryann C. Palmeter, CPC

  5. #5
    Jacksonville, Florida - 90417
    Default Audiology Coding
    As an added note, this is why we must use caution when we refer to "incident to billing."

    Audiology tests have never been covered under the incident to billing rules so the recent CMS transmittal was not issuing a change in that regard.

    -Maryann C. Palmeter, CPC

  6. #6
    Greeley, Colorado
    According to the transmittal, an Audiologists NPI will be required on all claims for services furnished by audiologists. Check out the American Academy of Audiology web site.

  7. Question audiology NPIs
    Hello, All!

    I'm new to the forums so forgive me if I do this wrong. I am an ENT coder from Columbus, Ohio and I need some clarification on the audiologist NPI billing issue. I'm not sure what to do. Do we bill audio services under the doctors' NPIs or the audiologists' NPIs? I'm getting conflicting information from several sources. When I read the CMS transmittal it sounds as though we do bill with the audiologists' NPI but that raises a lot of billing issues such as payment, 1099s, cash flow in our office due to lags in reimbursement. My understanding is that we would have to credential our audiologists with Medicare and that takes some time. Does anyone have any ideas?

    Confused in Columbus

  8. Default
    Hi All,

    Just received an email from CMS in reference to audiology services. The posting on CMS's website follows:

    Delay of Enrollment for Employed Audiologists Billing Under a Physician
    On February 29, 2008, the Centers for Medicare & Medicaid Services (CMS) issued change request 5717 (CR) titled “Update to Audiology Policies.” Transmittal 1470 of that change request provided clarifications to the Medicare Claims Processing Manual (Pub. 100-02). In Pub 100-02, Chapter 12, Section 30.3, the manual instructions state, “. . . the audiologist's NPI is required on all claims for services furnished by audiologists.” Use of the NPI in the primary identifier field on a claim requires Medicare enrollment.
    Note that CMS is instructing contractors to, prior to October 1, 2008, continue to process claims without the NPI of the audiologist. All other instructions in CR 5717 remain unchanged.
    CMS will require the use of the NPI on claims for diagnostic test services furnished by audiologists on or after October 1, 2008. Audiologists are encouraged to obtain an NPI and enroll as soon as possible.
    Note: This delay only applies to audiologists who are employed by and billing under a physician's NPI. Independent audiologist are not entitled to this delay and therefore subject to the mandatory NPI requirements.
    Source: CMS Joint Signature Memorandum 08252, April 3, 2008

    Hope it helps,


  9. Default

    Thank you for your post; it certainly helps! It gives our office some breathing room.


  10. #10
    Greensboro, NC
    I also received the notice from the Academy of Audiologists, and from CMS.
    Practices now need to get NPI's and Medicare numbers if they are going to provide services for Medicare patients. The deadline is October, 2008.

    Cynthia Robinson, RT, CPC

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