Audiology Services

• Generally, Medicare covers audiology services as “other diagnostic tests” (see section 1861(s)(3) of the Social Security Act), and they're paid under the Physician Fee Schedule (PFS)
• Medicare covers audiology services furnished to an outpatient of a hospital as “diagnostic services” (see section 1861(s)(2)(C) of the Social Security Act), and they're paid under the hospital Outpatient Prospective Payment System (OPPS)
• Medicare covers and pays for audiology services based on the reason the tests are ordered or directly accessed, as appropriate, rather than by the patient’s diagnosis or condition
• View the list of audiology services HCPCS codes (ZIP) (Updated 11/24/2023)

Does Medicare Require a Physician’s Order for Audiology Services?

Generally, Medicare requires a physician’s order for audiology services in all settings. However, for dates of service on or after January 1, 2023, CMS created an exception to the physician order requirement at 42 CFR 410.32(a)(4) to allow patients to directly access audiologists. 

Once every 12 months, a patient can see an audiologist without an order for certain diagnostic tests personally furnished by audiologists. This includes tests for non-acute hearing conditions but doesn’t include tests for disequilibrium or imbalance. Use the AB modifier when you bill for these tests. To find out which audiology tests may be billed with the AB modifier, view the list of audiology services HCPCS codes (see link in the previous section). 

What Services Aren’t Covered by Medicare?

Medicare doesn’t cover or pay for:

• Therapeutic services, like auditory rehabilitation (see Medicare Benefit Policy Manual, Chapter 15 (PDF), section 80.3).
• Hearing aids and bone conduction hearing aids. But, under 42 CFR 411.15(d)(2), Medicare covers certain specific devices that replace the function of the middle ear, cochlea, or auditory nerve as prosthetic devices including auditory osseointegrated, cochlear, and auditory brainstem implants (see Medicare Benefit Policy Manual, Chapter 16 (PDF), Section 100). 
• Audiology services under the benefit for services “incident to” a physician’s service (see Medicare Benefit Policy Manual, Chapter 15 (PDF), Section 60) because audiologists have their own Medicare benefit that allows them to bill for audiology services they personally furnish.

Where Can I Get More Information?

• Contact the Medicare Administrative Contractor (MAC) that pays your Part B claims to get answers to specific Medicare billing questions. Find your MAC's website.
•  If you have trouble getting a response from your MAC, email your CMS Regional Office.