Information for physicians
Effective May 1, 2013
Medicare may deny audiology claims if the claim lacks the name of the a medicare enrolled ordering/referring physician and their associated NPI in box 17 of the HCFA 1500 form.
The ordering/referring physician must be enrolled in Medicare as a participating provider, non-participating provider, or opt-out provider.
The following providers may order/refer for audiology services
- Certified Nurse Midwives
- Clinical Nurse Specialists
- Clinical Psychologists
- Clinical social workers
- Interns, Residents, and Fellows
- Nurse Practitioners
- Physician Assistants
- Physicians (MDs, DOs, Dentists, Podiatrists, Optometrists)
The order should include the service (ie audiology evaluation, hearing aid services) and the diagnosis code (ICD-9).
Some common symptoms include …
- “I hear but can’t understand”.
- Sensation of “fullness” or pressure in ears
- Speech/language delay
- Difficulty understanding in noise
- Sudden hearing loss
- Dizziness, vertigo, or unsteadiness
- Tinnitus, head noises, ringing in the ears
Possible etiologies include but are not limited to …
- Acoustic Neuroma
- Bell’s Palsy
- Benign Paroxysmal Positioning Vertigo
- Cerumen Impaction
- Eustachian Tube Dysfunction
- Labyrinthitis
- Meniere’s Disease
- Migraine
- Otitis Media
- Ototoxic Drug Reaction
- Peripheral Hearing Loss
- Presbycusis
- Sensorineural Hearing Loss Secondary to Noise Exposure