This guide aims to provide coding, billing, and coverage guidance for audiology services delivered via telehealth.
Insurance coverage for telehealth services varies depending on the payer. Generally, if a service is not covered when provided in person, it will also be non-covered if delivered via telehealth. Therefore, services that are not covered in-person will remain non-covered when provided remotely. For unique or specific situations, it is advisable for professionals to contact the payer directly for guidance on coding and billing for telehealth services.
Clinicians are strongly encouraged to reference payer-specific policies when determining appropriate code reporting and documentation requirements for audiologic telehealth services. Further, there may be additional regulatory considerations (e.g., state licensure and scope of practice) that should be considered prior to providing and billing telehealth services in audiology.
Telehealth Sites and State Regulation
In the provision of telehealth, there are two distinct sites: the originating site and the distant site.
- The originating site is where the patient requests services and is often indicated on the claim form with the patient's physical address.
- The distant site is where the practitioner provides services, identified by place-of-service (POS) codes.
Practitioners providing telehealth services should be familiar with the state laws and regulatory policies of the originating site. Providers must be licensed in the state where the originating site (patient side) is located for providing telehealth services.
Place-of-Service (POS) Codes and Telehealth Modifiers
For the provision of audiology services via telehealth, it is important to notate the place of service (POS) on claim forms. Below are some common examples of POS codes.
POS Code 11—Office is the primary POS code used for typical face-to-face procedures provided by audiologists. Current convention is to report Code 11 when providing telehealth services to assure similar rates to in-person services. Payers may also require a modifier to be added to the procedure code.
POS Code 02—Telehealth Provided Other than in Patient’s Home is a POS code used to indicate services provided through a telecommunications system. For Medicare claims, we do not recommend reporting the POS Code 02. Instead, Medicare asks practitioners to report the POS Code 11—Office and append the -95 (Telehealth) modifier to current procedural terminology (CPT) codes representing the remote services performed. However, other payer-specific policies may recommend the use of POS Code 02.
POS Code 10–Telehealth Provided in Patient’s Home is a POS code used to services provided through a telecommunications system. For Medicare claims, we do not recommend reporting the POS Code 10. Instead, Medicare asks practitioners to report the POS Code 11—Office and append the -95 (Telehealth) modifier to current procedural terminology (CPT) codes representing the remote services performed. However, other payer-specific policies may recommend the use of POS Code 10.
A full list of Medicare-related POS codes can be found here.
Certain payers may require practitioners to append modifiers when reporting clinical services provided via telehealth. Below are some examples of commonly used telehealth modifiers.
Modifier -95
This modifier indicates that services were provided synchronously (in real time) over a HIPAA-compliant communication technology. The modifier is commonly used by Medicare alongside POS Code 11 for reporting clinical procedures performed via synchronous telehealth.
Modifier -GT
This modifier indicates that services were provided synchronously (in real time) over a HIPAA-compliant communication technology. Medicare no longer uses this modifier to indicate telehealth services, but some payers may ask for reporting of this modifier in lieu of the modifier -95.
Modifier -GQ
This telehealth modifier may be used by specific payers under certain circumstances. Required usage of this modifier has become rare in recent years, as reporting conventions have evolved.
Medicare Coverage Policies for Audiology Services Provided via Telehealth
Medicare Local Coverage Determinations and other payer policies will address which ICD codes support medical necessity and subsequent reimbursement for audiology services provided via telehealth. A list of audiology services covered through Medicare is provided below in Table 1 (approved for telehealth provision as of May 1, 2020).
Generally, if a service is not covered when provided in person, it will also not be covered if delivered via telehealth. Therefore, services that are not covered in-person will remain non-covered when provided remotely. For Medicare services that are never covered when performed by audiologists, a voluntary Advance Beneficiary Notice (ABN) can be issued, but is not required. More information regarding use of the ABN in audiology is provided elsewhere (Resources: ABN Quick Reference Guide). If the claim must be submitted to Medicare for denial, the GY or GY/GX modifier(s) would apply.
List of Medicare-Covered Audiology Services Provided via Telehealth (benefit category set to expire January 1, 2025)
During the COVID-19 public health emergency, Medicare extended coverage of certain coverage procedures when provided via telehealth. The continued coverage of telehealth services under Medicare is effective through December 31, 2024, unless congress approves a permanent telehealth policy for 2025 and beyond.
Table 1. Audiology procedure codes covered under Medicare when provided via telehealth (approved as provision May 1, 2020; telehealth expansions set to expire January 1, 2025) (CMS, 2024)
| CPT | SHORT DESCRIPTOR | CPT | SHORT DESCRIPTOR |
| 92550 | Tympanometry & reflex threshold | 92570 | Acoustic immittance testing |
| 92552 | Pure tone audiometry air | 92587 | Evoked otoacoustic emissions, limited |
| 92553 | Audiometry air & bone | 92588 | Evoked otoacoustic emissions, complete |
| 92555 | Speech threshold audiometry | 92601 | Cochlear implant f/up exam >= 7 years |
| 93556 | Speech audiometry complete | 92602 | Reprogram cochlear implant < 7 years |
| 92557 | Comprehensive hearing test | 92603 | Cochlear implant f/up exam >= 7 years |
| 92563 | Tone decay test | 92604 | Reprogram cochlear implant >= 7 years |
| 92565 | Stenger test, pure tone | 92625 | Tinnitus assessment |
| 92567 | Tympanometry | 92626 | Eval auditory function 1st hour |
| 92658 | Acoustic reflex testing, threshold | 92627 | Eval auditory function each addl 15 min |
| List of Telehealth Services | |||
Telehealth Audits
Practitioners should comply with all requirements for the provision of telehealth services. The increased adoption of telehealth services means the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has increased its review of telehealth services provided under the Medicare and Medicaid programs.
Frequently Asked Questions
- What can I do if insurance does not provide coverage for audiology procedures or general consultations provided via telehealth?
- Can audiology services be provided via telehealth?
- Are there specific telehealth office visit or consultation codes for audiology?
- What documentation is required for telehealth services?
- Do I need a license to practice in every state where my patients access telehealth services?
- How do I know if my state licensure’s scope of practice includes telehealth provision? And if it is part of the scope, how do I know what the licensure-defined regulatory boundaries are as part of that care?
CPT codes, descriptions, and other data are Copyright 1966, 1970, 1973, 1977, 1981, 1983–2024 American Medical Association. All rights reserved. CPT© is a registered trademark of the American Medical Association.
Disclaimer
The purpose of the information provided by the American Academy of Audiology Coding and Reimbursement Committee is strictly for educational guidance to audiologists. Action taken with respect to the information provided is an individual choice. The American Academy of Audiology hereby disclaims any responsibility for the consequences of any action(s) taken by any individual(s) as a result of using the information provided, and reader agrees not to take action against, or seek to hold, or hold liable, the American Academy of Audiology for the reader's use of the information provided. As used herein, the "American Academy of Audiology" shall be defined to include its directors, officers, employees, volunteers, members, and agents.
