Practical Implications of Enactment of the Audiology Patient Choice Act: Part 1 “Direct Access”

Author: Kim Cavitt, Au.D.

For traditional Medicare coverage of medically necessary audiologic and vestibular diagnostic testing, the patient must secure an order from their treating physician or qualified non-physician practitioner (Medicare Benefit Policy Manual, sections 80.3 and 80.6). This order must be secured prior to the provision of the service. Technically, the Centers for Medicare and Medicaid Services (CMS) believe that the patient is being seen by the ordering/treating physician, that the patient is reporting an audiologic and/or vestibular condition that warrants assessment and that this physician is initiating the order.

The providers authorized to order testing include the following (Click here for more information):
  • Physician (Doctor of Medicine or Osteopathy, Doctor of Dental Medicine, Doctor of Dental Surgery, Doctor of Podiatric Medicine, Doctor of Optometry),
  • Physician Assistant,
  • Certified Clinical Nurse Specialist,
  • Nurse Practitioner,
  • Clinical Psychologist,
  • Certified Nurse Midwife,
  • Clinical Social Worker, and
  • Interns, residents, and fellows.
State licensure contains no order requirements for audiology services. Most state Medicaid programs, Medicare Part C (Advantage) and private insurance plans (other than HMOs) do not require any form of order or prior authorization prior to audiologic or vestibular evaluations. This is somewhat unique to traditional Medicare.
What would passage of the Audiology Patient Choice Act mean to audiologists and our patients?
Passage would mean that audiologists and their patients would no longer have to secure the physician order as a precursor to receiving legitimate coverage of medically necessary audiologic and/or vestibular testing (this is commonly referred to as “Medicare direct access”). This would improve access, costs and efficiencies in the delivery of hearing, communication and balance care. This could lead to increased awareness and treatment of hearing, communication, tinnitus and/or vestibular symptoms and disorders.    
Dr. Kim Cavitt was a clinical audiologist and preceptor at The Ohio State University and Northwestern University for the first ten years of her career. Since 2001, Dr. Cavitt has operated her own Audiology consulting firm, Audiology Resources, Inc. She currently serves on the State of Illinois Speech Pathology and Audiology Licensure Board. She also serves on committees through AAA and ASHA and is an Adjunct Lecturer at Northwestern University.