Q: Does Medicare require the CCCs and, if you have discontinued membership in ASHA, are you ineligible to bill Medicare?
A: Credentialing within Medicare is licensure-based and not certification-based. Medicare law defines audiology services as “such hearing and balance assessment services furnished by a qualified audiologist as the audiologist is legally authorized to perform under State law as would otherwise be covered by a physician.” The Medicare statute was amended in 1994 to define “qualified audiologist” as “an individual with a master’s or doctoral degree in audiology who is licensed as an audiologist by the State in which the individual furnishes services or, in states without licensure, has completed 350 hours of supervised practicum, 9 months of supervised full-time work after obtaining a master’s or doctoral degree and who has passed a national exam.”(42 U.S.C. § 1395x(ll)(3)(B). CMS has issued two program memorandums to clarify that certification is not necessary for participation as a Medicare provider.
Q: Is ABA certification currently recognized by the Secretary of Health and Human Services as a national examination in audiology for “qualified audiologist” for Medicare reimbursement?
A: Currently, Medicare does not explicitly recognize board certification in Audiology by the American Board of Audiology (ABA) as a qualification for Medicare reimbursement. It does however recognize state licensure. The Medicare statute was amended in 1994 to define “qualified audiologist” in terms of state licensure. Thus, an individual with a master’s or doctoral degree in audiology who is licensed as an audiologist by the state in which he or she provides services is a “qualified audiologist” for the purposes of Medicare reimbursement. In states that do not have licensure laws, the statute defines a “qualified audiologist” as an individual with a master’s degree in audiology who has successfully completed 350 clock hours of supervised clinical practicum, performed not less than nine months of supervised full-time audiology services after obtaining their degree, and successfully completed a national exam in audiology.
Q: In the clinic setting, who would be considered “qualified” to perform CPT code 92552 screening test, pure tone, air only or CPT code 92567 tympanometry?
A: The Academy feels that an audiologist is the only “qualified” professional to perform audiologic and vestibular studies and supervise hearing screening in any setting by virtue of their training, knowledge base, and state license or registration to practice audiology. In the few states without licensing or registration (2), membership in and adherence to the Code of Ethics of the American Academy of Audiology coupled with ABA Certification are recommended for credentialing. Please see the Audiologist scope of practice.
It is the Academy’s position that audiologic studies should be completed by an audiologist and that hearing screening must be supervised by an audiologist in the best interests of those being served. See the Position Statement and Guidelines of the Consensus Panel on Support Personnel in Audiology.
