September 30, 2021
My ENT doctor ordered an audiogram to be done by our audiologist. The doctor billed for the audiogram to a non-Medicare payor because the audiologist is not credentialled with that payor. Can my doctor “get credit” for ordering and reviewing the audiogram when he chooses the E/M code level? What happens when it’s a Medicare patient and the audiologist bills for the audiogram herself – what credit does the doctor get?
Good questions and I know it can be confusing. Let’s look at your scenarios separately:
- Audiogram ordered and billed by the doctor: CPT guidelines are clear that if you order the test, and you bill for it, then you do not get Category 1 Data credit for ordering or reviewing.
- Audiogram ordered by the doctor and billed by the audiologist: Since the doctor is not billing for the test, s/he gets Category 1 Data credit for the test order. However, s/he does not receive Category 1 Data credit for the review because s/he ordered the test.
In neither situation does the doctor receive Category 2 Data credit for the independent interpretation for an audiogram because the audiogram code, 92557, does not have separate professional and technical components.
*This response is based on the best information available as of 9/30/21.