Billing for ENGs Performed by Technicians

Question

Answer

If the balance clinic is a physician clinic and the case can be made that a physician is supervising the balance/vestibular testing conducted by a technician, there should be no problem because of the wide range in the physician scope of practice in state licensure. Medicare has specific requirements for "incident to physician's services" as well as physician supervision. This and other factors regarding audiology and Medicare are found in ASHA's Medicare Handbook for Audiology. Medicare requirements for hearing and balance services are clear in the statute - "The term 'audiology services' means such hearing and balance assessment services furnished by a qualified audiologist as the audiologist is legally authorized to perform under State law (or the State regulatory mechanism provided by State law), as would otherwise be covered if furnished by a physician." There is no provision for services provided under the supervision of audiologists. You should not be concerned with reimbursement for technicians rendering hearing screening because very few health insurance plans will pay for it.

Steven C. White, PhD, is the Director of the Health Care Economics and Advocacy at the ASHA National Office. White, an ASHA Fellow, is ex officio to the Health Care Economics Committee. His responsibilities include Medicare, private health insurance and Medicaid especially coding and outpatient reimbursement policies as they relate to these payers. White is the staff liaison to the American Medical Association Current Procedural Terminology Editorial Panel and the AMA Relative Value Update Committee. He has published and presented extensively on third party reimbursement. White is co-author with Janet McCarty of Health Plan Coding and Claims Guide (2005), Negotiating Health Care Contracts and Calculating Fees (2004), Appealing Health Plan Denials, and Getting Your Services Covered. White is also coauthor with Ingrida Lusis and Mark Kander of the Medicare Handbook for Speech-Language Pathologists (2004) and the Medicare Handbook for Audiologists (2005). White holds a PhD in audiology from Wayne State University and an MS in speech-language pathology and audiology from Ithaca College.