No physician order
Medicare and many plans deny diagnostic testing without a referral unless the AB modifier conditions are met. Core MB confirms the order or AB eligibility at verification and attaches the referral where required.
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Audiology medical billing services
Audiology billing separates diagnostic testing, which most insurers cover with a physician order or the Medicare AB modifier, from hearing aid evaluation and dispensing, which many plans do not cover. Claims pay when the test battery is coded without overlap, laterality rules are respected, the order requirement is met, and hearing aid benefits are verified before the fitting.
What makes audiology billing different
Audiology has test bundling rules, order requirements and hearing aid benefit structures that general billing teams rarely see.
- Comprehensive audiometry under 92557 includes pure tone air and bone plus speech testing, so 92552, 92553, 92555 and 92556 are not billed alongside it, and the full battery must be documented to support the comprehensive code.
- Immittance testing is reported as 92550 when tympanometry and acoustic reflex are both performed, with 92567 and 92568 reserved for a single component, and 92570 when reflex decay is added.
- Vestibular evaluation uses 92540 for the basic battery and 92537 or 92538 for caloric testing, while auditory evoked potentials are coded 92650 through 92653 by purpose, from screening to comprehensive threshold estimation.
- Medicare allows audiologists to bill certain non-acute hearing and balance tests without a physician order once per year using the AB modifier, and hearing aid services under 92590 through 92595 and V-codes are generally non-covered.
Denials we see most in audiology
Every denial gets a root cause, a fix and a feedback loop, so the same denial stops coming back.
Test codes bundled
Payers reject component codes billed with the comprehensive code or deny 92567 with 92550. We audit every test battery for overlap and bill the correct combination before submission.
Hearing aid benefit denied
Fittings and devices are rejected when the plan has no hearing aid benefit or requires a specific supplier. Core MB verifies the benefit, the supplier requirement and the allowance before the patient commits.
How Core MB bills for audiology
Core MB bills audiology from the test report, coding each battery without overlap, applying the AB modifier and unilateral reductions correctly and separating covered diagnostics from hearing aid services. Credentialing and payer enrollment for new audiologists run in the same client portal. Credentialing for new providers runs in the same system, tracked live in your client portal.
- Each payer's hearing aid benefit, allowance and supplier rules are verified and documented before devices are ordered.
- Test batteries are reviewed for comprehensive versus component coding and bilateral versus unilateral modifiers.
- Physician orders and AB modifier eligibility are confirmed and tracked per patient for Medicare diagnostics.
Everything in the service
Core MB manages the complete billing cycle for audiology practices, including the credentialing that lets new audiologists bill diagnostic services from their first day.
- Insurance verification and eligibility checks
- Charge entry and specialty-specific coding review
- Claim scrubbing and electronic submission
- Payer follow-up on every open claim
- Denial management and appeals
- Payment posting and reconciliation
- Accounts receivable recovery
- Patient statements and balance support
- Monthly reporting you can read in five minutes
- Provider credentialing and payer enrollment
Audiology billing questions
When can we use the AB modifier for Medicare patients without an order?
The AB modifier lets an audiologist bill a defined set of diagnostic tests for non-acute hearing conditions and certain balance assessments without a physician order, limited to once every twelve months per patient. Tests outside that list or outside the window still need an order. Core MB checks eligibility and the date of the last AB claim before billing.
Why are we losing money on hearing aid fittings and follow-ups?
Most Medicare and many commercial plans do not cover 92590 through 92595 or the V-code device and fitting lines, and plans with a benefit often route it to a third-party administrator. We verify the actual benefit, the required network and the patient's responsibility up front so the practice collects what is owed at the point of service.
How do we bill when we only test one ear?
Most audiology codes describe bilateral testing. When a test is performed on one ear only, the 52 modifier for reduced services is appended and the report should state why only one ear was tested. Core MB confirms laterality from the test report and applies the modifier so the claim is accurate.
How do we get started with Core MB for audiology billing?
Send the quote form with your payer mix, your hearing aid dispensing volume and your software. We set up a transition that runs new claims alongside your current billing so cash flow holds steady, and credentialing or payer enrollment for your audiologists can begin at the same time in the same portal.
Audiology billing that separates diagnostics from devices
Core MB codes test batteries correctly, manages orders and the AB modifier, and verifies hearing aid benefits for audiology practices across the country.