Two questions my staff and I get on a regular basis are: #1.)“Does Medicare pay for hearing tests? Also: #2.) “If the tests show that I need hearing aids, will Medicare pay for the devices?”
The answer to question #1 is that Medicare does not cover routine hearing exams. When I say routine, I am referring to regular hearing testing done at the request of the patient for the purpose of determining the extent of hearing difficulties, much the same as any other healthcare checkup.
Diagnostic audiological services are paid for, by Medicare, when a physician orders testing to obtain information to determine the appropriate medical or surgical treatment of a hearing deficit or related medical problem.
However, services are excluded when the diagnostic information required to determine the appropriate medical or surgical treatment is already known to the physician, or when the diagnostic services are performed only to determine the need for hearing aids or hearing aid reprogramming.
If the need for testing and hearing technology does not come under the specific guidelines outlined above, then the patient is responsible for 100% of the professional fees.
As for question #2.), the same is true for hearing aids, which under Federal law are considered “cosmetic” items. Whether or not you agree with this, the law has stood this way for decades and it would take an act of Congress to change the national coverage policy.
That said, as a consumer you should be aware of any audiologist or hearing aid dispenser who tells you “yes” they will bill Medicare for your non-referred hearing tests and/or hearing aids. This practice is illegal, and as a consultant and special witness for the FBI, I can tell you that the Federal Government is not taking these fraudulent acts lightly. In fact, they are cracking down on this activity and have recently prosecuted cases here in California.
To find out more about Medicare coverage for hearing care services and technology, visit the official U.S. Government site at www.medicare.gov.
If you have more questions about hearing care, such as diagnostic testing and hearing technology, you can visit my website or call my office toll free at 1.888.893.1352…Because hearing is a wonderful gift!”