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Marla Posted Thu 02nd of November, 2017 11:16:15 AM
Do audiologists get paid at 100% of the Medicare allowable for an audiogram - CPT code 92557 and tympanogram - CPT code 92567 when they are not billed incident to the physician?
SuperCoder Answered Fri 03rd of November, 2017 02:36:56 AM


According to the Medicare Benefit Policy, "Audiological diagnostic tests are not covered under the benefit for services incident to a physician's services because they have their own benefit as "other diagnostic tests."

Any audiology service that an audiologist provides must be billed to Medicare under the NPI of the audiologist who performed the service. The audiologist's NPI should be listed in box 24J of the CMS 1500 form with each service performed. When an audiologist completes audiology testing, the audiologist's NPI should be used for billing regardless of practice setting or to whom payment is made.

Incident to" billing requires physician supervision, and therefore, audiology services performed by technicians must be directly supervised by a physician, not an audiologist. In order for services of a non-physician practitioner to be covered as "incident to" the services of a physician, the services must meet all of the requirements for coverage. For example, the services must be an integral, although incidental, part of the physician's personal professional services, and they must be performed under the physician's direct supervision. Direct supervision means the physician is available in the same building and immediately available to provide direction during testing by the technician. With such supervision, the physician's NPI could be used, assuming the services qualify as "incident to." Additionally, services performed by technicians that are permitted to be billed "incident to" a physician's services are limited to those services having a Technical Component (TC) and Professional Component (PC) and include tympanometry, otoacoustic emissions, auditory brainstem response testing and vestibular testing. There are many services that do not qualify, including CPT code 92557. For additional details and a definitive list of what procedures technicians can provide and bill, contact your regional Medicare Administrative Contractor (MAC).

Marla Posted Mon 06th of November, 2017 09:00:48 AM
I am sorry....I don't feel that my question has been answered and need further clarification please. I understand that I am not to bill the audiology services incident to. I am merely asking if audiologists get paid 100% of the allowable for an audiogram and tympanogram or if they are paid at a lower percentage of the Medicare allowable.
SuperCoder Answered Tue 07th of November, 2017 04:55:15 AM

Hi Marla,

The audiologists get paid 100% of the allowable for an audiogram and tympanogram.

Please let us know if you are facing any reimbursement issues so that we ca provide correct resolution to your problem.

Further query is welcome.



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