Billing For Cerumen Removal

Mon Sep 21 08:50:17 EST 1998

Re:  Medicare patients and cerumen removal.  Physician referral is necessary
for any procedures provided by audiologists for Medicare patients.  Medicare
covers only those audiology diagnostic procedures needed to help the physician
determine whether medical or surgical treatment is possible.  Routine hearing
tests are not a covered benefit.  Audiologists may not bill Medicare for
cerumen removal, nor for any of the evaluation and management codes which
physicians use, such as 99211, etc.  I believe that physicians also cannot
bill Medicare separately for cerumen removal because it is considered part of
the office visit coding.

Re: billing private insurance companies for cerumen removal - it depends, just
as the need for physician referral depends on the individual policy.  In NY
state, HMO's require primary care physician referral for all procedures
performed by audiologists.  PPO's do not have the same requirement for
referral.  In a number of PPO's, patients may access audiology services
without referral.  The coverage of cerumen removal depends on the individual
policy.  In NY, there is a law which states that if a policy covers a
procedure, and that procedure is part of the audiologist's scope of practice,
the policy must cover the procedure when performed by an audiologist.  Cerumen
removal is part of our scope of practice here, and therefore I could bill for
it if the insurance policy covers it when a physician performs it.  These laws
are commonly called "any willing provider" laws.  Angela Loavenbruck

More information about the Audiolog mailing list