Does Medicare Require a Referral for Audiology Exams?

About

Medicare 101

Current Clients

Does Medicare Require a Referral for Audiology Exams?

Senior woman receiving an ear exam stock photo

By Daniel Petkevich

Nov 22, 2022

Guidance has been updated recently

As you may know already, Medicare does not cover hearing aids. But you can still get Medicare coverage for tests for hearing and balance. In most cases, you will need a referral from a physician to get this covered by Medicare. The CMS (Center for Medicare & Medicaid Services) just released updated guidance for the exception for when you don't need a referral. Let's dig into it.

Speak with a Medicare Advocate

Talk to one of our Licensed Medicare Agents today to find the right plans for you.

When do you need an audiology exam?

You will need an audiology exam if you want to find out how well your ears are working and to determine the best treatment for any hearing issues. This may include having balance tests and learning more about assistive devices such as hearing aids, implants, or other treatments.

Audiology Exams and Medicare Coverage

Luckily, if you need an audiology exam, Medicare has you covered. This exam does require pre-authorization though. The exam must be performed by an audiologist who is an enrolled Medicare provider. If you do not have a referral from your physician, you may be able to use the Exception Request, which has recently been filed with the CMS.

What are the conditions that must be met for the exception to apply?

According to the CMS, "(t)he finalized policy will allow beneficiaries direct access (without an order from a physician or NPP) to an audiologist, but only for non-acute hearing conditions." So , if your hearing condition is not acute or emergent, and you are being seen for non-acute issues, then Medicare will need authorize the audiology exam to be eligible for coverage.

What to do if you don't have a referral?

If you don't have a referral from your physician for an audiology exam and meet the criteria for the exception, you may submit an Exception Request to Medicare. This must be done before the exam is performed, and you will need to provide all supporting documentation such as physician notes and lab results with your request. Once approved, Medicare will pay for the exam and any related services.

And as with hearing aids, Medicare might not have the same coverage as Medicare Advantage plans. You might want to check with your plan provider directly for specific coverage details.

We hope this guide helps you understand what Medicare covers regarding audiology exams. If you have any questions, please don't hesitate to reach out to us for more information. We're here to help!

Speak with a Medicare Advocate

Talk to one of our Licensed Medicare Agents today to find the right plans for you.

Your Medicare One-Stop-Shop

Your guide to Medicare Parts A & B, Medicare Advantage, and Medigap. 100% free.

Get the Fair Square Bulletin

Medicare savings tips, helpful guides, and more.

888-454-2383

info@fairsquaremedicare.com

About

Medicare 101

Current Clients

Medicare Supplement Plans

Medicare Advantage Plans

Fair Square 2025

•

Notice of Privacy Practices

Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2025 Help Button Inc

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

MULTIPLAN_FairSquareMedicare_01062022_M

Does Medicare Require a Referral for Audiology Exams?

Guidance has been updated recently

Speak with a Medicare Advocate

When do you need an audiology exam?

Audiology Exams and Medicare Coverage

What are the conditions that must be met for the exception to apply?

What to do if you don't have a referral?

Speak with a Medicare Advocate

Recommended Articles

More of our articles

Your Medicare One-Stop-Shop

About

Medicare 101

Current Clients

Medicare Supplement Plans

Medicare Advantage Plans