Audiological Evaluation is
the determination of the range, nature and degree of hearing loss including
measuring hearing acuity, tests relating to air and bone conduction, speech
reception threshold and speech discrimination and other hearing evaluation
tests as appropriate including conformity evaluations and pure tone audiometry.
To claim
Medicaid reimbursement, providers must abide by the following:
·
A
medical referral in writing from a NYS licensed and registered physician, registered
physician’s assistant under the supervision of a NYS licensed physician, or a
licensed nurse practitioner within the scope of the Nurse Practice Act is
required prior to the audiological evaluation.
·
Audiological
evaluations must be performed by a NYS licensed and registered audiologist and
the credentials of the audiologist should be kept on file.
·
The
evaluation must be part of the IEP process.
Documentation Requirements: A signed and dated audiological report of the
information described in the definition above should contain the following
information as applicable:
·
Client’s
identifying information, date of birth, date of testing.
·
A
plot of air conduction and bone conduction thresholds.
·
The
results of speech audiometry (Speech Reception Threshold or SRT and speech
discrimination scores, which are called word recognition scores in more recent
literature).
·
Record
of any other testing completed (e.g. tympanograms, which are done to assess
middle ear function or tests done to assess how someone’s hearing aids
function, if applicable).
·
Response
technique (how the testing was done, conventional or other).
·
Reliability
(i.e. were the responses consistent).
·
A
narrative explanation and interpretation of the findings (hearing levels,
degree and type of hearing loss, if any, etc.).
·
Recommendations
(e.g., refer to physician for follow up, or re-test in X amount of time).
The
credentials of the audiologists should be kept on file.
Codes and Fees:
|
SSHSP (NYC) Fee |
5303 |
$
160 |
|
SSHSP (Rest of
State) Fee |
5303 |
$
130 |
|
PSHSP Individual
& Center based (NYC) Fee |
5371 |
$ 190 |
|
PSHSP Individual
& Center based (Rest of State) Fee |
5371 |
$
155 |