What is the AB modifier for audiology direct access?

Modifier AB allows an audiologist to bill Medicare directly for certain non-acute hearing assessment services without a physician or nonphysician practitioner order, under a rule finalized in the CY2023 Medicare Physician Fee Schedule and effective for claims processing since July 1, 2023. It applies to a specific list of CPT codes published by CMS, excludes vestibular and balance testing codes entirely, and can be used once every 12 months per patient. Billing one eligible code with modifier AB blocks all other AB-eligible codes for that same patient for the next 12 months, regardless of how many were performed on the same date.

What changed in audiology CPT codes for 2026?

Effective January 1, 2026, CPT deleted the legacy hearing aid service codes 92590 through 92595, which had been in use since 1993, and replaced them with 12 new codes across five categories: candidacy evaluation, hearing aid selection, fitting and follow-up, verification, and assistive device services. These new codes currently carry no assigned Medicare RVUs and remain non-payable under Medicare due to the statutory hearing aid exclusion. They apply only to air-conduction devices; implantable device programming codes such as 92601 through 92604 are unchanged.

Specialty Billing

Audiology Billing 2026: AB Modifier, New Codes and Denial Prevention

Q: Does Medicare cover hearing aids?

No. Hearing aids themselves remain statutorily excluded from traditional Medicare Part B coverage under Section 1862(a)(7) of the Social Security Act, and this has not changed despite the complete overhaul of hearing device billing codes effective January 1, 2026. The new codes exist for billing transparency and for commercial payer and Medicaid use, not because Medicare now reimburses hearing aids. Diagnostic audiology services that assess hearing loss remain separately covered as diagnostic tests under Part B, which is a distinct benefit category from the hearing aid device itself.

By Rcmaxis Revenue Cycle Team · August 2026 · 14 min read

Audiology clinic exam room for audiology billing 2026 guide

Effective January 1, 2026, CPT deleted every hearing aid service code that had been in use since 1993 and replaced them with 12 new codes — and none of them are payable under Medicare.Source: ASHA and American Academy of Audiology, CY2026 Medicare Physician Fee Schedule summaries

Audiology billing runs on a smaller code set than most specialties, which makes it easy to assume it's simple. It isn't — it's precise in a way that punishes small mistakes. One modifier decides whether Medicare pays a diagnostic claim directly to the audiologist or denies it outright. One frequency limit, applied per patient per year rather than per visit, quietly blocks claims that look perfectly correct on their face. And in 2026, an entire category of codes changed structurally in a way that's easy to misread as a coverage expansion when it's actually the opposite.

This guide covers the direct access rule that's been reshaping how audiologists bill since 2023, the 2026 hearing device code overhaul, the vestibular testing bundling rules that generate quiet, recurring denials, and the real enforcement cases that show what happens when documentation doesn't match what was actually billed.

Diagnostic Audiology CPT Codes

Diagnostic audiology billing is built around a handful of core test families: pure tone and speech audiometry, vestibular and balance testing, tympanometry, otoacoustic emissions, and evoked potentials.

CPT Code	Description	Key Note
92557	Comprehensive audiometry (air/bone pure tone plus speech threshold and recognition)	Generally not billed same-day as 92552/92553 by the same provider
92567	Tympanometry	Limited to once per month for patients on ototoxic medications
92587 / 92588	OAE screening (limited) / OAE diagnostic (comprehensive)	588 requires 12 or more frequencies with quantitative results
92585 / 92586	Auditory evoked potentials: comprehensive / limited	92585 was the code at the center of a real $4 million OIG settlement — see below
92540	Basic vestibular evaluation battery	Only 2 of the 5 individual vestibular component codes (92541, 92542, 92544, 92545, 92546) are payable per patient per year
92601-92604	Cochlear implant programming, by age and initial vs. subsequent	Cannot be billed same-day as 92584 (electrocochleography)
92622 / 92623	Auditory osseointegrated device programming (first 60 min / each additional 15 min)	Added to Medicare's Telehealth Services List for 2026

Frequency limits are annual, not per-visit: Several audiology codes are capped at how often they can be billed per patient per year, not just per visit — the 2-of-5 vestibular component rule is the clearest example. A claim that looks completely correct in isolation can still deny if it's the third qualifying vestibular code billed for that patient in the same 12-month period. Track utilization at the patient level, not just the claim level.

The AB Modifier: Direct Access Since 2023, Expanded in 2024

Here's a correction worth making explicitly, because it's easy to get wrong: Medicare's audiology direct access rule is not a 2024 policy. It was finalized in the CY2023 Medicare Physician Fee Schedule, became regulation effective January 1, 2023, and its claims-processing edits went live July 1, 2023. What did happen in 2024 was an expansion — CMS added two more codes to the eligible list that year.

The rule allows audiologists to bill Medicare directly, using modifier AB, for certain non-acute hearing assessment services without requiring a physician or nonphysician practitioner order first. The original list covered 36 CPT codes; the 2024 addition of osseointegrated device programming codes 92622 and 92623 brought the total to 38. Vestibular and balance testing codes are explicitly excluded — don't bill those with AB, CMS will return the claim.

AB Modifier Detail	Rule
Regulatory effective date	January 1, 2023 (CY2023 MPFS final rule, 42 CFR 410.32(a)(4))
Claims-processing effective date	July 1, 2023
2024 expansion	Added codes 92622 and 92623; 36 codes became 38
Frequency limit	Once per patient per 12-month period, regardless of how many eligible codes are billed
Explicitly excluded	Vestibular/balance testing codes, hearing aid exams and fittings, disequilibrium-related testing
Billing route restriction	No incident-to option — audiologist must personally furnish and bill the service under their own NPI

One AB claim locks the whole list for 12 months: Billing a single eligible code with modifier AB blocks every other AB-eligible code for that same patient for the next 12 months — not just that specific code. If a patient needs a different qualifying test three months later, it can't go through AB again until the 12-month window resets. Build this into your scheduling and billing logic so you're not surprised by a denial on a legitimately needed follow-up test.

The 2026 Hearing Device Code Overhaul: Not a Coverage Expansion

This is the change most likely to cause confusion on your billing team this year. Effective January 1, 2026, CPT deleted the hearing aid service codes 92590 through 92595 — codes that had been in continuous use since 1993 — and replaced them with 12 new codes across five categories: candidacy evaluation, hearing aid selection, fitting and follow-up, verification, and assistive device services like FM/DM systems.

It would be reasonable to look at 12 new specific codes and assume Medicare finally started paying for hearing aid services. It didn't. These new codes currently have no assigned RVUs and remain non-payable under Medicare, because the statutory hearing aid exclusion under Section 1862(a)(7) of the Social Security Act hasn't changed. The codes exist for billing transparency and for commercial payer and Medicaid use where coverage does exist. Bill Medicare with these codes expecting reimbursement, and you'll get a denial that has nothing to do with your documentation and everything to do with a benefit category exclusion that predates the code changes by decades.

What to check before billing hearing device services in 2026:

Confirm payer type first — Medicare Part B will not reimburse the new 92628-92642 series regardless of documentation quality
For Medicare Advantage patients, check the specific plan's supplemental hearing benefit — nearly all MA plans now offer one, but they route through third-party hearing networks like TruHearing, Amplifon, or EPIC with plan-specific rules
For commercial and Medicaid patients, confirm the payer has actually loaded the new 2026 codes into their system before submitting — new code sets sometimes outpace payer system updates
Watch H.R. 500, the Medicare Hearing Aid Coverage Act of 2025, as a "if this changes" item — it remains stalled in committee and shouldn't be billed against as though it were active

OIG Enforcement: What Actual Audiology Fraud Cases Look Like

Audiology doesn't have the same volume of OIG Work Plan activity as larger specialties, but the enforcement cases that do exist are specific and instructive. Hearing Screening Associates, an Illinois provider, agreed to pay just over $4 million in April 2023 after self-disclosing that it billed CPT 92585 — comprehensive auditory evoked potentials — for services where audiologists never actually read, interpreted, or signed the automated test results. In other words, the claim represented physician-level interpretation work that simply never happened.

An older case, Towson University's Speech Language & Hearing Center, paid $10,000 in 2015 for submitting audiology claims under incorrect NPI numbers that didn't identify the audiologist who actually performed the service. That case is worth remembering specifically in the context of the AB modifier rule: because AB claims require the audiologist to personally furnish and bill under their own NPI, attribution accuracy matters more under the current rules than it did when that settlement happened.

Incident-to billing is an active current audit focus: OIG's Work Plan added a project in November 2024 examining Medicare Part B incident-to payments broadly — it doesn't name audiology specifically, but ASHA and AAA's own incident-to guidance flags audiology technician services like tympanometry, OAE, and vestibular testing as a recognized incident-to gray area. Diagnostic audiology services performed by a technician can be billed incident-to a physician; services an audiologist personally furnishes as a direct Medicare benefit cannot. Confirm your practice's billing matches which category each service actually falls into.

Common Audiology Denial Patterns and Fixes

Denial Reason	Root Cause	Fix
AB modifier claim denied	Patient already had an AB-eligible code billed within the prior 12 months, or the code billed is vestibular/excluded	Check AB usage history per patient before billing; confirm code is on CMS's current eligible list, not just clinically similar
Hearing device code denied by Medicare	New 2026 codes 92628-92642 billed to Medicare Part B, which doesn't pay them	Route hearing device services to Medicare Advantage supplemental benefit or private pay; use the codes only for payers that actually cover them
Vestibular component denied as frequency limit exceeded	Third qualifying component code billed for the patient within the 12-month cap of two	Track vestibular component billing at the patient-year level, not per visit
Incident-to billing rejected on audit	Audiologist-personally-furnished service billed incident-to a supervising physician instead of directly	Confirm which services qualify as direct audiologist benefits versus technician-performed incident-to services before billing
Evoked potential claim flagged	Documentation doesn't show the audiologist actually interpreted results, only that the test was run	Require a signed interpretation note for every 92585/92586 claim, not just the automated printout

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References

CMS. MLN Matters MM13055: Allowing Audiologists to Provide Certain Diagnostic Tests Without a Physician Order. cms.gov
CMS. Audiology Services (Physician Fee Schedule page, AB modifier code list). cms.gov
CMS. Calendar Year 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F). cms.gov
CMS. Billing and Coding: Vestibular and Audiologic Function Studies (Article A57434). cms.gov
HHS Office of Inspector General. Hearing Screening Associates Agreed to Pay $4 Million for Allegedly Violating the Civil Monetary Penalties Law. oig.hhs.gov, April 2023
HHS Office of Inspector General. Medicare Part B Payments for Incident To Services (Work Plan, OAS-25-01-003). oig.hhs.gov
American Speech-Language-Hearing Association. Audiology CPT and HCPCS Code Changes for 2026. asha.org
American Academy of Audiology. CMS Finalizes CY 2026 Physician Fee Schedule: Key Takeaways for Audiology. audiology.org
Congress.gov. H.R.500 — Medicare Hearing Aid Coverage Act of 2025, 119th Congress. congress.gov
KFF. Medicare Advantage 2025 Spotlight: A First Look at Plan Premiums and Benefits. kff.org