6 Tips to Navigate Audiology Billing Challenges

Helping patients hear better can be a joy and a privilege for audiologists. Billing and collection for audiology services? Maybe not so much. Hearing care teams may struggle to sort out audiology CPT codes, third-party payer policies, Medicare reimbursements and more.

Healthcare billing is not only complex, but any errors or miscommunications along the way may cause costly delays in payer coverage and reimbursements, which can impact an audiology practice’s revenue cycle management. Effective, accurate audiology billing can be so important — for both the hearing care team and their patients and clients.

These audiology billing guidelines can help practices navigate this complex process.

Common Audiology Billing Challenges

Audiology billing can be challenging. Here are some of the key hurdles audiology practices may grapple with:

Navigating third-party payers

A central question for audiology practices is which and how many third-party payers and insurance companies to do business with. Accepting a long list of payers may allow a hearing care team to maximize the number of patients they can serve, but with every new insurance company comes a new set of coverage rules, reimbursement rates, provider agreements and administrative processes. Aside from Medicare, which audiologists cannot opt out of if they offer Medicare-covered services, evaluating third-party payers and determining which to incorporate into the practice’s healthcare billing and collection procedures can be a complex task.¹

Keeping complex coverage rules straight

Hearing care professionals can recommend audiology services to patients that will benefit their health and lifestyles, while also considering any budget concerns their patients may have. Audiology coverage can differ widely across payers and policies. Determining what is covered — and therefore feasible for each patient — can be a case-by-case challenge. 

Juggling inconsistent reimbursement rates

Insurance company reimbursement is an important revenue source for many audiology practices.² But inconsistent reimbursement rates and procedures across payers may make pricing and offering audiology services challenging from patient to patient. Errors and appeals can cause delays, prolonging the reimbursement process and potentially creating cash flow challenges for audiology practices.² 

Handling prior authorization denials

In theory, prior authorization should make healthcare billing smoother, as the third-party payer is approving a service in advance. In reality, obtaining prior authorization can be challenging. Delays and denials can lead to canceled or rescheduled appointments, which can delay treatment for patients and revenue for audiology practices.³

Medicare and Medicaid Limitations

Despite the direct connection between aging and hearing loss, almost 90% of Medicare beneficiaries who report hearing problems do not own hearing aids.⁴ⁿ Medicare does not cover hearing aids or exams for fitting those devices.⁵ 

Medicaid, on the other hand, sometimes covers certain audiology services, but which ones and how much vary by state.⁶ This can make standardizing billing and collection procedures for hearing care services challenging for hearing care providers.  

6 Tips for Effective Audiology Billing

Audiology billing challenges may exist, but they are manageable. A little know-how can go a long way toward getting ahead of issues. Avoiding denials and delays can help boost your audiology practice’s revenue cycle management with these audiology billing guidelines.

1. Know your audiology billing codes

Smooth audiology billing begins with accurate coding.⁷ Errors can result in third-party payers rejecting claims, delaying and complicating the process. Specific codes do change, so staying up to date can be key.⁸ Here are some of the code types that hearing care professionals may want to know:⁷  

• Current Procedural Terminology (CPT®). CPT codes have five digits and are maintained by the American Medical Association. They describe hearing care services and procedures, such as a diagnostic test or hearing aid fitting.

• Healthcare Common Procedure Coding System (HCPCS). Most HCPCS codes describe supplies, equipment and devices, like hearing aids. These codes are maintained by the Centers for Medicare and Medicaid Services (CMS), with involvement from other third-party payers. CMS refers to CPT codes as HCPCS Level I, and its own codes as HCPCS Level II.

• ICD-10-CM (International Classification of Diseases, 10th revision, Clinical Modification). ICD-10-CM codes represent diagnoses and disorders. They are maintained by the National Center for Health Statistics and are typically not billable.

2. Learn about timed and untimed codes

Timed codes are typically used in speech language pathology services, but audiologists benefit from understanding the distinction between timed and untimed codes, as they do apply to a small number of audiology services, and to avoid incorrect billing.⁹

Timed codes include a time designation in the code descriptor, such as “per hour” or “each additional 30 minutes,” and can be billed multiple times per day. Untimed codes can only be billed once a day for the entirety of a service.⁹

3. Distinguish between bilateral and unilateral services

Many CPT codes assume services apply to both ears and are therefore bilateral. However, in cases where services apply to only one ear, hearing care teams should include a modifier designation in the billing code.⁹

4. Understand when to use modifiers

Audiology billing code modifiers add additional description to a code, including if a service was reduced in some way or is distinct from a similar billed service. For example, to distinguish a unilateral service from a code that typically represents a bilateral service, a modifier of -52 is often added. Other common modifiers that your hearing care practice may want to know include:¹⁰ 

• Modifier -22, which can be used to designate extended services that may require additional equipment

• Modifiers RT or LT to differentiate between the right and left ears

5. Note each payer’s policies 

Audiology practices often do business with Medicare, Medicaid and both in- and out-of-network private insurers. Each of these third-party payers can have very different processes, coverage and reimbursements. Understanding how they differ can be helpful in audiology billing. 

For example, Medicare will cover only diagnostic services deemed medically necessary.¹¹ Many private insurers, however, may cover preventive care.¹² Reimbursement rates can vary widely, too: Medicare’s reimbursements are based on a federal fee schedule, but insurance companies negotiate their own reimbursement rates. 

Even within the same private insurer, policies may vary widely from plan to plan. For example, the same insurance company may offer a premium plan that waives deductibles for hearing services, while a more basic plan does not.¹³

6. Decide when to bundle or unbundle services

Some hearing care services that normally have distinct audiology CPT codes can be bundled together under a single procedure code.¹⁴ This can simplify billing for services, and even devices, that are commonly delivered together. For example, hearing care teams can bill for all devices and services associated with a hearing aid evaluation, fitting and management under one code. 

Unbundling, on the other hand, is the procedure of itemizing each code. While bundling may provide simplicity, itemization provides additional transparency. Some third-party payers require unbundling codes, so it is critical to understand which codes and payers accept bundling. 

General Audiology Billing Best Practices

Once a hearing care team has internalized the guidelines above, these audiology billing best practices can help billing go smoothly:

• Verify prior authorization requirements before scheduling appointments.¹⁵
• Make sure all audiology CPT codes are as descriptive as possible, including any necessary modifiers.¹⁰
• Review all paperwork for accuracy before submission.⁷
• Appeal claim denials immediately after identifying the cause for the denial and addressing the issue.¹⁵

Navigate Billing, Focus on Patients

Hearing care teams work hard to serve their patients’ audiology needs. Without effective billing and collection, however, that can be challenging. Understanding third-party payers’ requirements and audiology billing codes can help hearing care professionals navigate billing obstacles and focus more on helping patients.

A Patient Financing Solution for Your Hearing Care Practice

If you want to help your patients manage the cost of your practice’s exams, procedures and products, consider offering the CareCredit credit card as a financing solution. CareCredit allows cardholders to pay for things like hearing care services and devices over time while helping to enhance the payments process for your practice.

When you accept CareCredit, patients can see if they prequalify with no impact to their credit score, and those who apply, if approved, can take advantage of special financing on qualifying purchases.* Additionally, you will be paid directly within two business days.

Learn more about the CareCredit credit card as a patient financing solution for your hearing care practice or start the provider enrollment process by filling out this form.

Author Bio

Natalie Burg is a writer, editor and editorial project manager with 20 years of experience. She uses her expertise from a range of industries, including economic development, business, sustainability and more, to create content that educates and engages readers.

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