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Q: How do manufacturers get exclusive benefits with third party payers and why can’t audiologists get the same recognition for the services they provide?

A: Certain manufacturers have been offering benefit deals for some time now. This is not an uncommon arrangement, whereby a provider offers discounted services to members of a benefit plan. Insurance companies like it because they are able to extend hearing benefits without any cost.

Providers, on the other hand, like it because it provides a marketing avenue through the trusted insurance company. Other groups, audiologists included, have offered similar discounting. Groups and individual practitioners have the same opportunity to submit a plan to develop discounting to insurance companies. The reason groups are considered is usually because of that group’s geographic coverage of an area in which the insurance company’s clients reside. The fact that others have an equal opportunity to develop discounting plans and be considered as providers reduces the insurance company’s liability regarding exclusivity. If another group can offer lower discounts for subscribers, the more attractive they become to that insurer, thus creating the opportunity for the insurer to allow one or both groups to operate with the beneficiary being given “choice”.

Q: Is there a code that allows reimbursement for two audiologists working on one patient, such as is necessary when working with difficult-to- test children?

A: There is no CPT code or modifier for reporting services performed by two audiologists. Many audiologists use CPT codes 92579 and/or 92582 and/or 92583 along with the actual test done for reimbursement of difficult-to-test children when employing techniques that require assistance. CPT code 92582 (conditioning play audiometry) seems to be a popular code for the process of conditioning the children to respond to sound stimuli… There may be a need for creative scheduling (e.g. book out one audiologist for the entire visit with one just for half of the visit whereby the testing is occurring).

Q: I work in an audiology department, which is an outpatient department of a rural hospital in Texas. JCAHO is scheduled to survey our facility. Are there any standards for audiology as an outpatient facility or is it more of a broad grouping of “outpatient/ department?

A: There is no document that addresses outpatient programming. However, you may want to review the following Position Statements/Guidelines formally issued by the Academy:

  • Audiology Clinical Practice Algorithms and Statements
  • Audiology: Scope of Practice
  • Consensus Panel on Support Personnel in Audiology: Position Statement and Guidelines
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