Medicare Claims Processing with AB Modifier for Limited Direct Access

The Academy has learned from members across the country about denials they are receiving for Medicare claims submitted using the AB modifier. The denials relate specifically to Box 17 on the claim form, which asks for a referring provider. 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 notified the Centers for Medicare and Medicaid Services (CMS) of the denials earlier this month and discussed the situation further in a recent meeting with CMS representatives. In all of our communications, the Academy has underscored the need for a fast resolution. CMS is working to resolve the problem as soon as possible and will issue further guidance.

The Academy will continue to monitor and share with members any updates and guidance as they become available, either directly from CMS or through the Medicare Administrator Contractors (MACs). 

When using the AB modifier currently with Medicare claims, audiologists may expect to receive denials or a delay in claims processing until the issue is resolved.