ADA and AAA Join Forces to Benefit the Profession

Working cooperatively for the benefit of the profession, the American Academy of Audiology and the Academy of Dispensing Audiologists have forged a new awareness and understanding of our profession at the Health Care Financing Administration (HCFA). Recently, we have won two important victories for audiologists and for the patients we serve:

HCFA has ruled that Medicare carriers may not automatically deny reimbursement for hearing tests because they result in a diagnosis of sensorineural hearing loss and fitting of a hearing aid.

Some Medicare carriers have been routinely denying claims for reimbursement of any hearing tests that result in a diagnosis of sensorineural hearing loss. AAA and ADA have been urging HCFA to make clear that this practice is inappropriate, and HCFA agreed, in a letter written to the Academies last year. Now, it's official. HCFA has issued a Medicare Program Memorandum (PM) to carriers stating that Medicare coverage is determined by 'the reason the tests were performed. rather than the diagnosis.' If audiologic diagnostic tests are ordered by a physician as a necessary part of a medical evaluation, Medicare covers them - even if the tests do not discover any medically treatable condition.

The Program Memorandum (Transmittal B-01-34), which becomes effective May 29, 2001, is available on HCFA's website.

HCFA has eliminated the physician supervision requirement for vestibular function tests with recording (CPT codes 92541-92548) when performed by a qualified audiologist.

In 1997, HCFA had stated that physician supervision was required for vestibular function tests with recording. AAA and ADA repeatedly questioned this policy in letters to and meetings with HCFA officials, and last year HCFA agreed with our position. Now, HCFA has issued a Medicare Program Memorandum stating that physician supervision is not required for vestibular and audiologic function tests payable under the Medicare Physician Fee Schedule when such tests are personally performed by a qualified audiologist.

The Program Memorandum (Transmittal B-01-28), which becomes effective July 1, 2001, is available on HCFA's website.

The American Academy of Audiology and the Academy of Dispensing Audiologists are proud of this accomplishment. Obviously, the long-term goal is that audiologists receive reimbursement for diagnostic hearing evaluations without the need for physician referral, and Health and Human Services Secretary Tommy Thompson, which oversees the FDA, HCFA (including both Medicare and Medicaid programs), and NIH, is in a position to help us tremendously. In his address at the AAA Opening General Assembly two weeks ago, Secretary Thompson stated that he will work with us, and we look forward to working towards our goal of autonomous hearing healthcare service provision by audiologists. Thank you for your efforts and your support to the Academys' leadership!