One AB modifier claim locks every other AB-eligible code for that patient for 12 months, and Hearing Screening Associates paid $4 million in 2023 for billing evoked-potential tests audiologists never actually interpreted.
Common Billing Challenges
These are the six billing failure points we see most often in audiology practices — and the ones our team resolves systematically from day one.
Billing one eligible code with modifier AB blocks every other AB-eligible code for that patient for the next 12 months, not just that specific code.
Vestibular and balance testing codes are explicitly excluded from AB direct access — CMS returns those claims outright.
The 2-of-5 vestibular component rule and similar caps apply per patient per year, not per visit — a claim that looks correct in isolation can still deny as the third qualifying code in 12 months.
The new 92628-92642 series has no assigned RVUs and remains non-payable under Medicare due to the Section 1862(a)(7) statutory exclusion, regardless of documentation quality.
A signed interpretation note is required for every 92585/92586 claim — Hearing Screening Associates paid $4 million after billing for automated results audiologists never actually read.
Services an audiologist personally furnishes as a direct Medicare benefit can't be billed incident-to a supervising physician; OIG's Work Plan added a Part B incident-to project in November 2024.
Key Procedure Codes
Our coders hold specialty-specific credentials and train continuously on the codes that drive the most revenue — and the most denials — in audiology.
| CPT Code | Description | Common Issue |
|---|---|---|
| 92557 | Comprehensive audiometry | Not generally billed same-day as 92552/92553 by same provider |
| 92587/92588 | OAE screening / diagnostic | 92588 requires 12+ frequencies with quantitative results |
| 92585/92586 | Auditory evoked potentials, comprehensive / limited | Needs a signed interpretation note — center of a $4M OIG settlement |
| 92540 | Basic vestibular evaluation battery | Only 2 of 5 component codes payable per patient per year |
| 92601-92604 | Cochlear implant programming | Can't bill same-day as 92584 (electrocochleography) |
| 92628-92642 | 2026 hearing device service codes | No Medicare RVUs assigned — non-payable under Part B |
Why Rcmaxis
We're not a generalist billing service that added a specialty module. Our team is built around specialty-specific expertise.
Every coder on your account holds the specialty coding credential relevant to audiology — not a generic CPC only.
Built around the frequency limits, AB modifier rules, and interpretation documentation that decide whether an audiology claim gets paid the first time.
Full EHR integration, payer enrollment verification, and charge capture setup in 2 weeks — with zero disruption to your clinic schedule.
One point of contact who knows your practice, your payers, and your billing history — available for weekly calls and monthly performance reviews.
Month-to-month engagement. We earn your business every month by improving your collections — not by locking you in.
Live visibility into your collections, denial rate, aging AR, and payer performance — updated daily, reviewed monthly with your account team.
Straight answers to what practices usually ask before they switch.
Free revenue assessment for qualified practices. We audit your last 90 days of claims, identify every revenue leak, and show you a clear path to better collections — at no cost.