JAMA Article Lays Path for Medicare Reimbursement of Hearing-Related Services

September 18, 2018

With OTC hearing aid regulatory guidelines looming, a few experts are beginning to consider the additional hearing rehabilitative services needed by some to ensure they receive maximum benefit from their purchase. Further, given the older population most in need of hearing aids, Medicare reimbursement for these clinical services is a significant issue.

The 2017 OTC Hearing Aid Act, which is expected to go into effect in 2020, intends to improve access and affordability of amplification devices for adults with mild to moderate hearing loss. A likely consequence of the OTC legislation is more individuals using hearing aids but avoiding necessary service because Medicare doesn’t cover it. Audiologist Nick Reed and colleagues at Johns Hopkins University, in a September 13 JAMA Online article, offered a path forward on Medicare reimbursement for the provision of clinical audiology services.


Medicare Coverage for Hearing Aids and Other Audiology Services?


Citing the well-known Humes et al study, published in AJA last year, Reed and colleagues mention that adults who receive counseling and communication strategies information through a best practice model experienced better outcomes. 

The authors also mentioned individuals with cognitive impairment, low health literacy, and without previous hearing care experience may be especially at risk for the inability to self-manage their condition after purchasing an OTC device, and thus require additional services from an audiologist.

As most readers know, hearing testing (unless ordered by a physician), hearing aids, and hearing care services are not covered by Medicare, and even if the 2017 OTC legislation improves hearing aid uptake, follow-up services provided by audiologists would still not be covered. To better understand how the marketplace for hearing-related services could change as a result of 2017 OTC legislation and the need for Medicare coverage of hearing-related services, it’s helpful to quote the author’s key points at length:

“In the context of future OTC hearing aids, one reasonable approach may be to leverage existing hearing rehabilitation Current Procedural Terminology (CPT)–coded (titled aural rehabilitation) reimbursement practices for speech-language pathologists as a benchmark for audiologists. The CPT codes for time-based aural rehabilitation (92626 for the first hour, 92627 for each additional 15-minute increment) already exist for audiologists, but these practices are not reimbursed by Medicare. In addition, Medicare reimburses speech-language pathologists for aural rehabilitation (CPT code 92507 at $79.92) under Medicare Part B; however, speech-language pathologists do not provide these services in relation to hearing aids and generally focus only on the communication counseling aspect. Audiologists could use the same CPT code (92507) for aural rehabilitation under Medicare Part B to provide communication counseling and auditory training, which would require hearing care to be redefined in the Medicare Act as medically necessary. Although these CPT codes would not necessarily support activities related directly to hearing aids (ie, programming and customization), these codes could support counseling to maximize benefit of OTC hearing aids among Medicare beneficiaries. Currently, no value-based cost-benefit study has specifically distinguished the use of hearing care services and devices. Future analyses will be necessary to support this policy.”

In addition to calling for changes in the use of CPT codes by audiologists to coverage hearing-related services, Reed and colleagues believe hearing aids and hearing services should be redefined as medically necessary thus enabling coverage by Medicare.

Their commentary provides one view of a future in which hearing related services are decoupled from the sale of a device and audiologists can receive Medicare reimbursement counseling patients and providing customizable services for a device that many have been purchased over-the-counter. The entire article can be found here


*featured image courtesy Alpha Stock Images

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