evekhm/cms_iom_500 huggingface dataset:
(Medicare Benefit Policy Manual)
The A/B MAC (B) must secure from the appropriate State agency a current listing of psychologists holding the required credentials to determine whether the tests of a particular IPP are covered under Part B in States that have statutory licensure or certifi cation.  In States or territories that lack statutory licensing or certification, the A/B MAC (B) checks individual qualifications before provider numbers are issued.  Possible reference sources are the national directory of membership of the American Psychological Association, which provides data about the educational background of individuals and indicates which members are board -certified, the records and directories of the State or territorial psychological association, and the National Register of Heal th Service Providers.  If qualification is dependent on a doctoral degree from a currently accredited program, the A/B MAC (B) verifies the date of accreditation of the school involved, since such accreditation is not retroactive.  If the listed reference sources do not provide enough information (e.g., the psychologist is not a member of one of these sources), the A/B MAC (B) contacts the psychologist personally for the required information.  Generally, A/B MACs (B) maintain a continuing list of psychologi sts whose qualifications have been verified.   NOTE:   When diagnostic psychological tests are performed by a psychologist who is not practicing independently, but is on the staff of an institution, agency, or clinic, that entity bills for the psychological tests.   The A/B MAC (B) considers psychologists as practicing independently when:    They render services on their own responsibility, free of the administrative and professional control of an employer such as a physician, institution or agency;    The persons they treat are their own patients; and    They have the right to bill directly, collect and retain the fee for their services.  A psychologist practicing in an office located in an institution may be considered an independently practicing psychologist when both of the following conditions exist:    The office is confined to a separately -identified part of the facility which is used solely as the psychologists office and cannot be construed as extending throughout the entire institution; and    The psychologist conducts a private practice, i.e., services are rendered to patients from outside the institution as well as to institutional patients.   Payment for Diagnostic Psychological and Neuropsychological Tests
(Medicare Benefit Policy Manual)
 The psychologist conducts a private practice, i.e., services are rendered to patients from outside the institution as well as to institutional patients.   Payment for Diagnostic Psychological and Neuropsychological Tests  Expenses for diagnostic psychological and neuropsychological tests are not subject to the outpatient mental health treatment limitation, that is, the payment limitation on treatment services for mental, psychoneurotic and personality disorders as authorized under Section 1833(c) of the Act.  The payment amount for the new psychological and neuropsychological tests (CPT codes 96102, 96103, 96119 and 96120) that are billed for tests performed by a technician or a computer reflect a site of service payment dif ferential for the facility and non-facility settings.  CPs, NPs, CNSs and PAs are required by law to accept assigned payment for psychological and neuropsychological tests.  However, while IPPs are not required by law to accept assigned payment for these tests, they must report the name and address of the physician who ordered the test on the claim form when billing for tests.   CPT Codes for Diagnostic Psychological and Neuropsychological Tests  The range of CPT codes used to report psychological and neuropsychological tests is 96101-96120.  CPT codes 96101, 96102, 96103, 96105, 96110, and 96111 are appropriate for use when billing for psychological tests.  CPT codes 96116, 96118, 96119 and 96120 are appropriate for use when billing for neuropsychological tests.  All of the tests under this CPT code range 96101-96120 are indicated as active codes under the physician fee schedule database and are covered if medically necessary.   Payment and Billing Guidelines for Psychological and Neuropsychological Tests
(Medicare Benefit Policy Manual)
Payment and Billing Guidelines for Psychological and Neuropsychological Tests  The technician and computer CPT codes for psychological and neuropsychological tests include practice expense, malpractice expense and professional work relative value units.  Accordingly, CPT psychological test code 96101 should not be paid when billed for the same tests or services performed under psychological test codes 96102 or 96103.  CPT neuropsychological test code 96118 should not be paid when billed for the same tests or services performed under neuropsychological test codes 96119 or 96120.  However, CPT codes 96101 and 96118 can be paid separately on the rare occasion when billed on the same date of service for different and separate tests from 96102, 96103, 96119 and 96120.  Under the physician fee schedule, there is no payment for services performed by students or trainees.  Accordingly, Medicare does not pay for services represented by CPT codes 96102 and 96119 when performed by a student or a trainee.  However, the presence of a student or a trainee while the test is being administered does not prevent a physician, CP, IPP, NP, CNS or PA from performing and being paid for the psychological test under 96102 or the neuropsychological test under 96119.  80.3 - Audiology Services  (Rev. 132, Issued: 09-03-10, Effective: 09-30-10, Implementation: 09 -30-10)  References .  1861(ll)(3) of the Social Security Act for the definition of audiology services.  1861(ll)(4)(B) of the Social Security Act for qualifications of audiologists.  42 CFR 410.32(b) for the physician supervision requirements for diagnostic tests.  Pub. 100-04, chapter 12, section 30.3 for coding and billing information related to audiological services and aural rehabilitation.  Pub. 100-02, chapter 15, sections 220 and 230 for the physical therapy and speech-language pathology policies relative to aural rehabilitation and balance, section 60 for services incident to a physicians service, and section 80.6 for policies relevant to ordering for diagnostic tests.  Pub. 100-02, chapter 16, section 100 for hearing aid policies.  A list of audiology services is found at: www.cms.gov/therapyservices.
(Medicare Benefit Policy Manual)
A.  Benefit.   Hearing and balance assessment services are generally covered as other diagnostic tests under section 1861(s)(3) of the Social Security Act.  Hearing and balance assessment services furnished to an outpatient of a hospital are covered as diagnostic services under section 1861(s)(2)(C).  As defined in the Social Security Act, section 1861(ll)(3), the term audiology services specifically means such hearing and balance assessment services furnished by a qualified audiologist as the audiologist is legally authorized to perform under State l aw (or the State regulatory mechanism provided by State law), as would otherwise be covered if furnished by a physician.  Herein after in this section, hearing and balance assessment services are termed audiology services, regardless of whether they are furnished by an audiologist, physician, nonphysician practitioner (NPP), or hospital.  Because audiology services are diagnostic tests, when furnished by a physician in an office or hospital outpatient department, they must be furnished under the appropriate level of supervision of a physician as established in 42 CFR 410.32(b)(1) and 410.28(e).  However, as specified in 42 CFR 410.32(b)(2)(ii) or (v), respectively, they are excepted from physician supervision when they are personally furnished by a qualified audiologist or performed by a nurse practitioner or clinical nurse specialist author ized to perform the tests under applicable State laws.   Audiological diagnostic testing refers to tests of the audiological and vestibular systems, e.g., hearing, balance, auditory processing, tinnitus and diagnostic programming of certain prosthetic devices, performed by qualified audiologists.  Audiological diagnostic tests are not covered under the benefit for services incident to a physicians service (described in Pub. 100-02, chapter 15, section 60), because they have their own benefit as other diagnostic tests.  See Pub. 100-04, chapter 13 for general diagnostic test policies.   Audiology services, like all other services, should be reported under the most specific HCPCS code that describes the service that was furnished and in accordance with all CPT guidance and Medicare national and MAC instructions.  B.  Orders.   Audiology tests are covered as other diagnostic tests under section 1861(s)(3)
(Medicare Benefit Policy Manual)
Audiology tests are covered as other diagnostic tests under section 1861(s)(3) or 1861(s)(2)(C) of the Act in the physicians office or hospital outpatient settings, respectively, when a physician (or an NPP, as applicable) orders such testing for the purpose of obtaining information necessary for the physicians diagnostic medical evaluation or to determine the appropriate medical or surgical treatment of a hearing deficit or related medical problem.  See section 80.6 of this chapter for policies regarding the ordering of diagnostic tests.   If a beneficiary undergoes diagnostic testing performed by an audiologist without a physician order, the tests are not covered even if the audiologist discovers a pathologic condition.  When a qualified physician orders a qualified technician (see definition in subsection D of this section) to furnish an appropriate audiology service, that order must specify which test is to be furnished by the technician under the direct supervision of a physician.  Only that test may be provided on that order by the technician.   When the qualified physician or NPP orders diagnostic audiology services furnished by an audiologist without naming specific tests, the audiologist may select the appropriate battery of tests.   C.  Coverage and Payment for Audiology Services.  Diagnostic services furnished by a qualified audiologist meeting the requirements in section 80.3.1 of this chapter or physicians and NPPs as described in section 80.6 are covered and payable under the MPFS as other diagnostic tests.  Services furnished in a hospital outpatient department are covered and payable under the hospital Outpatient Prospective Payment System (OPPS) or other payment methodology applicable to the provider furnishing the services.   Coverage and, therefore, payment for audiological diagnostic tests is determined by the reason the tests were performed, rather than by the diagnosis or the patients condition.  Under any Medicare payment system, payment for audiological diagnostic tests is not allowed by virtue of their exclusion from coverage in section 1862(a)(7) of the Social Security Act when:   The type and severity of the current hearing, tinnitus or balance status needed to determine the appropriate medical or surgical treatment is known to the physician before the test; or    The test was ordered for the specific purpose of fitting or modifying a hearing aid.  Payment of audiological diagnostic tests is allowed for other reasons and is not limited, for example, by:   Any information resulting from the test, for example:
(Medicare Benefit Policy Manual)
 The test was ordered for the specific purpose of fitting or modifying a hearing aid.  Payment of audiological diagnostic tests is allowed for other reasons and is not limited, for example, by:   Any information resulting from the test, for example:   Confirmation of a prior diagnosis;  Post-evaluation diagnoses; or  Treatment provided after diagnosis, including hearing aids, or   The type of evaluation or treatment the physician anticipates before the diagnostic test; or   Timing of reevaluation.  Reevaluation is appropriate at a schedule dictated by the ordering physician when the information provided by the diagnostic test is required, for example, to determine changes in hearing, to evaluate the appropriate medical or sur gical treatment or to evaluate the results of treatment.  For example, reevaluation may be appropriate, even when the evaluation was recent, in cases where the hearing loss, balance, or tinnitus may be progressive or fluctuating, the patient or caregiver complains of new symptoms, or treatment (such as medication or surgery) may have changed the patients audiological condition with or without awareness by the patient.   Examples of appropriate reasons for ordering audiological diagnostic tests that could be covered include, but are not limited to:   Evaluation of suspected change in hearing, tinnitus, or balance;   Evaluation of the cause of disorders of hearing, tinnitus, or balance;   Determination of the effect of medication, surgery, or other treatment;   Reevaluation to follow-up changes in hearing, tinnitus, or balance that may be caused by established diagnoses that place the patient at probable risk for a change in status including, but not limited to:  otosclerosis, atelectatic tympanic membrane, tympanosclerosis, cholesteatoma, resolving middle ear infection, Menires disease, sudden idiopathic sensorineural hearing loss, autoimmune inner ear disease, acoustic neuroma, demyelinating diseases, ototoxicity secondary to medications, or genetic vascular and viral conditions;   Failure of a screening test (although the screening test is not covered);   Diagnostic analysis of cochlear or brainstem implant and programming; and    Audiology diagnostic tests before and periodically after implantation of auditory prosthetic devices.
(Medicare Benefit Policy Manual)
 Failure of a screening test (although the screening test is not covered);   Diagnostic analysis of cochlear or brainstem implant and programming; and    Audiology diagnostic tests before and periodically after implantation of auditory prosthetic devices.  If a physician refers a beneficiary to an audiologist for testing related to signs or symptoms associated with hearing loss, balance disorder, tinnitus, ear disease, or ear injury, the audiologists diagnostic testing services should be covered even if the only outcome is the prescription of a hearing aid.  D.  Individuals Who Furnish Audiology Tests.  1. Qualified Professionals.  See section 80.3.1 of this chapter for the qualifications of audiologists.  See section 80.6 of this chapter for the qualifications of physicians and NPPs who may furnish diagnostic tests.  2.  Qualified Technicians or Other Qualified Staff .   References to technicians in this section include other qualified clinical staff.  The qualifications for technicians vary locally and may also depend on the type of test, the patient, and the level of participation of the physician who is directly supervising the test.  Therefore, an individual must meet qualifications appropriate to the service furnished as determined by the MAC to whom the claim is billed.  If it is necessary to determine whether the individual who furnished the labor for appropriate audiology services is qualified, MACs may request verification of any relevant education and training that has been completed by the technician, which shall be available in the records of the clinic or facility.   Depending on the qualifications determined by the MAC, individuals who are also hearing instrument specialists, students of audiology, or other health care professionals may furnish the labor for appropriate audiology services under direct physician supervision when these services are billed by physicians or hospital outpatient departments.  E.  Documentation for Audiology Services.  1.  Documentation for Orders (Reasons for Tests).  The reason for the test should be documented either on the order, on the audiological evaluation report, or in the patients medical record.  (See subsection C. of this section concerning reasons for tests.)  2.  Documenting skilled services .  When the medical record is subject to medical review, it is necessary that the record contains sufficient information so that the MAC may determine that the service qualifies for payment.  For example, documentation should indicate that the test was ord ered, that the reason for the test results in coverage, and that the test was furnished to the patient by a qualified individual.
(Medicare Benefit Policy Manual)
Records that support the appropriate provision of an audiological diagnostic test shall be made available to the MAC on request.  F.  Audiological Treatment.  There is no provision in the law for Medicare to pay audiologists for therapeutic services.  For example, vestibular treatment, auditory rehabilitation treatment, auditory processing treatment, and canalith repositioning, while they are generally within the scope of practice of audiologists, are not those hearing and balance assessment services that are defined as audiology services in 1861(ll)(3) of the Social Security Act and, therefore, shall not be billed by audiologists to Medicare.  Services for the purpose of hearing aid evaluation and fitting are not covered regardless of how they are billed.  Services identified as always therapy in Pub. 100-04, chapter 5, section 20 may not be billed by hospitals, physicians, NPPs, or audiologists when provided by audiologists.  (See also Pub. 100-04, chapter 12, section 30.3.)  Treatment related to hearing may be covered under the speech-language pathology benefit when the services are provided by speech-language pathologists.  Treatment related to balance (e.g., services described by always therapy codes 97001-97004, 97110, 97112, 97116, and 97750) may be covered under the physical therapy or occupational therapy benefit when the services are provided by therapists or their assistants, where appropriate.  Covered therapy services incident to a physicians service must conform to policies in sections 60, 220, and 230 of this chapter.  Audiological treatment provided under the benefits for physical therapy and speech -language pathology services may also be personally provided and billed by physicians and NPPs when the services are within their scope of practice and consistent with State and local laws.   For example, aural rehabilitation and signed communication training may be payable according to the benefit for speech -language pathology services or as speech-language pathology services incident to a physicians or NPPs service.  Treatment for balance disorders may be payable according to the benefit for physical therapy services or as a physical therapy service incident to the services of a physician or NPP.  See the policies in this chapter, sections 220 and 230, for details.  G.  Assignment.
(Medicare Benefit Policy Manual)
Nonhospital entities billing for the audiologists services may accept assignment under the usual procedure or, if not accepting assignment, may charge the patient and submit a nonassigned claim on their behalf.  H.  Opt Out and Mandatory Claims Submissions.  The opt out law does not define physician or practitioner to include audiologists; therefore, they may not opt out of Medicare and provide services under private contracts.  See section 40.4 of this chapter for details.   When a physician or supplier furnishes a service that is covered by Medicare, then it is subject to the mandatory claim submission provisions of section 1848(g)(4) of the Social Security Act.  Therefore, if an audiologist charges or attempts to charge a beneficiary any remuneration for a service that is covered by Medicare, then the audiologist must submit a claim to Medicare.  I.  Non-Audiology Services Furnished by Audiologists.  Audiologists may be qualified to furnish all or part of some diagnostic tests or treatments that are not defined as audiology services under the MPFS, such as non-auditory evoked potentials or cerumen removal.  Audiologists may not bill Medicare for services that are not audiology services according to Medicares definition (see list at:  www.cms.gov/therapyservices).  However, the labor for the Technical Component (TC) of certain other diagnostic tests or treatment services may qualify to be billed when furnished by audiologists under physician supervision when all the appropriate policies are followed.  When furnishing services that are not on the Medicare list of audiology services, the audiologist may or may not be working within the scope of practice of an audiologist according to State law.  The audiologist furnishing the service must have the qualifications that are ordinarily required of any person providing that service.  Consult the following policies for details:   Policies for physical therapy, occupational therapy, and speech-language pathology services are in sections 220 and 230 of this chapter and in Pub. 100-04, chapter 5, sections 10 and 20.   Policies for services furnished incident to physicians services in the physicians office are in section 60 of this chapter.   Policies for therapeutic services furnished incident to physicians services in the hospital outpatient setting are in chapter 6, section 20.5, of this manual.   Policies for diagnostic tests in the physicians office are in section 80 of this chapter.
(Medicare Benefit Policy Manual)
 Policies for therapeutic services furnished incident to physicians services in the hospital outpatient setting are in chapter 6, section 20.5, of this manual.   Policies for diagnostic tests in the physicians office are in section 80 of this chapter.   Policies for diagnostic tests furnished in the hospital outpatient setting are in chapter 6, section 20.4, of this manual.  Therapeutic or treatment services that are not audiology services and are not always therapy (according to the policy in Pub.100-04, chapter 5, section 20) and are furnished by audiologists may be billed incident to the services of a physician when all other appropriate requirements are met.   In addition, the TC or facility services for diagnostic tests that are not audiology services may be billed by physicians or hospital outpatient departments when provided by qualified personnel (who may be audiologists), and physicians and hospital outpatient departments may bill for these diagnostic tests when provided by those qualified personnel under the specified level of physician supervision for the diagnostic test.  80.3.1 - Definition of Qualified Audiologist  (Rev. 84; Issued:  02-29- 08; Effective:  04 -01-08; Implementation:  04 -07-08)  Audiological tests require the skills of an audiologist and shall be furnished by qualified audiologists, or, in States where it is allowed by State and local laws, by a physician or non- physician practitioner.  Medicare is not authorized to pay for these services when performed by audiological aides, assistants, technicians, or others who do not meet the qualifications below.  In cases where it is not clear, the MAC shall determine whether a service is an audiological service that requires the skills of an  audiologist and whether the qualifications for an audiologist have been met.  Section 1861(ll)(3) of the Act, provides that a qualified audiologist is an individual with a masters or doctoral degree in audiology.  Therefore, a Doctor of Audiology (AuD) 4th year student with a provisional license from a State does not qualify unless he or she also holds a masters or doctoral degree in audiology.  In addition, a qualified audiologist is an individual who:   Is licensed as an audiologist by the State in which the individual furnishes such services, or   In the case of an individual who furnishes services in a State which does not license audiologists has: