General Information

Since 2001, CMS has formally recognized qualified audiologists (specialty 64) to personally furnish diagnostic tests (Section 410.32(b)(2)(ii)) without supervision by a physician or NPP.

The statute, at section 1861(ll)(3) of the Social Security Act informs, audiology services that include such hearing and balance assessment services as the audiologist is legally authorized to perform under State law, as would otherwise be covered if the services were furnished by a physician. The definition of qualified audiologist appears at section 1861(ll)(4)(B) of the Act. Diagnostic tests are included as a Medicare Part B benefit under section 1861(s)(3) of the Act.

As defined in the Social Security Act, section 1861,(ll)(3), the term “audiology services” specifically means hearing and balance assessment services furnished by a qualified audiologist. Hearing and balance assessment services are termed “audiology services” regardless of whether they are furnished by an audiologist, physician, NPP, or hospital.

  • Limited to non-acute hearing conditions and diagnostic services related to implanted auditory prosthetic devices
  • Excludes audiology services that are related to disequilibrium, hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids
  • Covered once per patient per 12 month period
  • Unexpected discovery of an acute condition

What’s New

Prior to 1/1/2023, all hearing and balance assessment services furnished by audiologists required an order from the treating physician or NPP, including physician assistants, nurse practitioners, and clinical nurse specialists. However, via the CY 2023 PFS final rule (87 FR 69656 through 69663), CMS established a regulatory exception to that physician/NPP order requirement as it applies to audiologists at 42 CFR 410.32(a)(4) that permits audiologists to personally furnish certain diagnostic audiology tests without a physician/NPP order, once per beneficiary per 12-month period.

The finalized policy will allow beneficiaries direct access (without an order from a physician or NPP to an audiologist, but only for non-acute hearing conditions.

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Revised 4/9/2024