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