Allowing Audiologists to Furnish Certain Diagnostic Tests Without a Physician Order
The purpose of this Change Request (CR) is to establish edits to ensure the following: (a) that only one visit to an audiologist without a physician/NPP order is permitted, per beneficiary, once every 12 months, instructing that claims billed more frequently are denied; (b) that the visit may reflect one or more codes on an applicable list of 36 CPT codes, found in APPENDIX A, along with modifier AB, be billed via providers with certain bill types for outpatient hospitals, critical access hospitals, and SNFs; and, (c) that an audiologist’s National Provider Identifier (NPI) is the rendering provider on the line of service, with the AB modifier, which is alongside an applicable code found in APPENDIX A.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: June 15, 2023
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.