When we schedule a patient that has Medicare as their primary insurance, we always advise that a referral is required from their primary care doctor prior to testing. We are oftentimes met with opposition to this request and patients insist that they do not need a referral. While this is true for many types of medical appointments covered under Medicare, a referral is required for hearing testing. For more detailed information, please refer to the information below directly from Medicare and ASHA (The American Speech-Language-Hearing Association).
Information found on www.medicare.gov
Hearing and balance exams: Medicare Part B (Medical Insurance) covers diagnostic hearing and balance exams if your doctor or other health care provider orders them to see if you need medical treatment.
Information found on www.asha.org
Physician Order/Referral: Does Medicare require physician orders before an audiologist can perform an evaluation?
Chapter 15, §80.3, of the Medicare Benefit Policy Manual [PDF, 1.2MB] is clear on this subject. Medicare audiology coverage is part of the “other diagnostic tests” benefit and the performance of diagnostic tests requires an order from a physician, or, where allowed by State and local law, by a non-physician practitioner (NPP) as well as medical necessity. Under Medicare, a NPP is a physician assistant, nurse practitioner, or clinical nurse specialist. The tests are not covered if the physician/NPP order is obtained after the tests are performed. For further information, visit the Centers for Medicare and Medicaid Services (CMS) Audiology Services Web site. Please note, that the existence of a physician order does not guarantee that the threshold for medical necessity has been met. The diagnostic testing is only reimbursed by Medicare if it is reasonable and necessary.
