Did You Know: Medicare Covers Hearing Tests
In America today, hearing loss affects roughly nine million senior citizens. And while Medicare covers a variety of services, it has an elaborate approach when it comes to hearing aids and hearing tests. So, does Medicare pay for hearing aids? Unfortunately, the answer is no. Medicare also does not cover eye glasses or dentures. So what is covered? The first step when having any difficulty hearing is a hearing test, which Medicare will cover.
When it comes to hearing coverage, Medicare handles audiology diagnostic testing delivered by an audiologist only if a physician or non-physician specialist (ex. clinical nurse specialist) orders the test for any (or all) of the following reasons:
- Required information for the healthcare provider’s diagnosis
- Needed information to determine the appropriate medical or surgical treatment for a hearing condition or any related medical condition.
One good example here is when the hearing tests are useful to identify the cause of vertigo.
Hearing Test by an Audiologist
For Medicare to cover a hearing test, it’s important that the evaluation is done by an audiologist. According to Section 1861 of the Social Security Act, a qualified audiologist is someone who:
- has either a Master’s or Doctoral degree in Audiology
- has performed at least nine months of monitored full-time audiology services after receiving either a Master’s or Doctoral degree
- is a licensed audiologist (if s/he lives in a state that gives such authority)
- has completed (or is in the process of completing) 350 clock hours of monitored practicum (if s/he lives in a state that licenses audiologists)
- has passed a Secretary-approved national examination in audiology.
Also under Section 1861, audiology services are described as “other diagnostic tests”, with hearing and balance evaluations provided by a certified audiologist, doctor, or specialist conducting the services following the appropriate and applicable state laws. The coverage and settlement for audiology tests are based on the reason(s) the examinations were carried out, instead of the actual diagnosis or the condition of the patient.
Audiology services in the Medicare Benefit Policy Manual cover the:
- analysis of the reason for hearing disorders, tinnitus, or balance;
- analysis of diagnosed improvement or difference in hearing, tinnitus, or balance;
- assessment of the impact of hearing medication, surgery, or other procedure;
- reassessment to follow up shifts in hearing, tinnitus, or balance. This could be due to identified diagnoses that put the patient at possible risk. (This coverage – and its clause – requires a comprehensive discussion with a Medicare specialist.)
- regular audiologic analysis before and after an auditory prosthetic device implant.
Any audiology services supplied for the intention of hearing aid assessment and fitting have no Medicare coverage, no matter how they’re charged. But, if a doctor refers a beneficiary to an audiologist for screening relevant to symptoms of hearing loss, balance disorder, tinnitus, or other hearing disorders, the audiologist’s testing services must be covered, regardless if it only results to a hearing aid prescription.