CMS Releases Updated Guidance on AB Modifier

The Centers for Medicare and Medicaid Services (CMS) released further guidance for audiologists on billing for services using the AB modifier for limited direct access.  Effective January 1, 2023, the new Medicare policy for limited direct access allows audiologists to see beneficiaries without a physician order for non-acute hearing conditions and to bill 36 CPT codes using an AB modifier. The Academy is continuing to seek clarifications and further guidance from CMS, including about the latest information. We encourage members to report to us any problems encountered in following these CMS instructions.   

From the Thursday, March 16, 2023, weekly issue of MLN Connects:

Audiologists Can Furnish Certain Diagnostic Tests Without a Physician Order

Starting January 1, 2023, audiologists can furnish certain diagnostic audiology tests without a physician or non-physician practitioner (NPP) order using the AB modifier:

• Covered once per patient per 12-month period
• Limited to non-acute hearing conditions
• Excludes services related to:
  • Disequilibrium
  • Hearing aids
  • Exams for prescribing, fitting, or changing hearing aids

Tips when you bill with the AB modifier:

• Document good faith efforts were made to provide services for non-acute hearing conditions without the order of a treating physician or NPP so that the claim won’t deny if you unexpectedly discover an acute condition
• You can leave box 17 A & B (name and NPI of the referring provider) blank or incomplete

More Information:

• Audiology Services webpage
• CY 2023 Physician Fee Schedule final rule