Billing For Cerumen Removal

Jeffrey Sirianni audioman at hctc.net
Tue Sep 22 17:06:21 EST 1998


At 08:22 AM 9/21/98 EDT, EARTODAY at aol.com wrote:

>Re:  Medicare patients and cerumen removal.  Physician referral is
>necessary for any procedures provided by audiologists for Medicare
>patients.

Agree...

>Medicare covers only those audiology diagnostic procedures needed to
>help the physician determine whether medical or surgical treatment is
>possible.

Agree...

>Routine hearing tests are not a covered benefit.

WHAT ????

We're getting back to the argument of "which comes first, the procedure or
the diagnosis?"

I'm (still) under the impression that diagnostic services (audiometric
testing) are covered by Medicare if certain symptoms are present, such a
tinnitus, dizziness, sudden hearing loss, AND impacted cerumen.  Are you
saying that ENT's can bill and collect from Medicare for audiometric
services performed in their offices (as long as an acceptable diagnosis
code is given), but a private practice audiologist cannot?  What the heck
is going on here?

>Audiologists may not bill Medicare for cerumen removal

I understand that cerumen management is helpful when it comes to hearing
aid fittings, but why would anyone take a risk of injury to the EAC, take
advanced training courses in cerumen management (and pay money for such),
if no financial reimbursement is being made by Medicare to the practioner
who performs these services?

>nor for any of the evaluation and management codes which physicians use,
>such as 99211, etc.

99211: Office visit not requiring the presence of a physician....

I agree on this code, but not on diagnostic codes....

Are you saying that there are NO private practice audiologists billing and
collecting for diagnostic services from Medicare, even with acceptable
codes?  If anyone out there is doing such, PLEASE RESPOND and set the
record straight?

>I believe that physicians also cannot bill Medicare separately for
>cerumen removal because it is considered part of the office visit coding.

Physicians cannot bill for cerumen removal AND diagnostic testing if
performed on the same day.  Otherwise, an office visit charge and a cerumen
removal charge is quite acceptable by Medicare.


>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

If cerumen managment is consider part of an audiologist's scope of
practice, as you report above, why is it denied by Medicare?  Certainly AAA
and ASHA should be working toward this.....

I really appreciate your comments Angela, but as honest as your comments
may be, they are certainly pretty grim when AAA is calling for audiology
autonomy.  In order for an autonomous private practice to survive
financially, their must changes in reimbursement laws.  In other words, if
we are not getting paid by Medicare for services provided, we're pretty
much giving away our services.

Can you tell us, as a AAA board member, is AAA working to change Medicare
reimbursement rules in favor of private practice audiologists?

Jeff


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