Does Medicare Require a Referral for Audiology Exams?
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
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!
Recommended Articles
How to Choose a Medigap Plan
Jan 10, 2023
What Happens to Unused Medicare Set-Aside Funds?
Jan 20, 2023
Does Medicare Cover Hearing Aids?
Nov 9, 2022
Does Medicare Cover SI Joint Fusion?
Nov 28, 2022
Does Medicare Cover the WATCHMAN Procedure?
Dec 1, 2022
Will Medicare Cover Dental Implants?
Jun 2, 2022
How to Apply for Medicare?
Jul 15, 2022
14 Best Ways for Seniors to Stay Active in Nashville
Mar 10, 2023
Does Medicare Cover Krystexxa?
Nov 18, 2022
Do I Need to Renew My Medicare?
Nov 29, 2022
Does Medicare Cover Cold Laser Therapy (CLT)?
Jun 14, 2023
Does Medicare Pay for Bunion Surgery?
Nov 29, 2022
Why Is Medicare So Confusing?
Apr 19, 2023
What Is a Medicare Supplement SELECT Plan?
Apr 25, 2023
Medicare Advantage MSA Plans
May 17, 2023
What is the Medicare ICEP?
Apr 7, 2023
Is Vitrectomy Surgery Covered by Medicare?
Dec 2, 2022
2024 Cost of Living Adjustment
Nov 13, 2023
More of our articles
2025 Medicare Price Changes
Are Medicare Advantage Plans Bad?
Can I Change My Primary Care Provider with an Advantage Plan?
Can I switch From Medicare Advantage to Medigap?
Comparing All Medigap Plans | Chart Updated for 2025
Costco Pharmacy Partners with Fair Square
Do All Hospitals Accept Medicare Advantage Plans?
Do You Need Medigap if You're Eligible for Both Medicare and Medicaid?
Does Medicare Cover Abortion Services?
Does Medicare Cover Bariatric Surgery?
Does Medicare Cover Boniva?
Does Medicare Cover Compounded Medications?
Does Medicare Cover COVID Tests?
Does Medicare cover Deviated Septum Surgery?
Does Medicare Cover Diabetic Eye Exams?
Does Medicare Cover Disposable Underwear?
Does Medicare Cover ESRD Treatments?
Does Medicare Cover Hypnotherapy?
Does Medicare Cover Ilumya?
Does Medicare Cover Incontinence Supplies?
Does Medicare Cover Ketamine Infusion for Depression?
Does Medicare Cover Light Therapy for Psoriasis?
Does Medicare Cover Lipoma Removal?
Does Medicare Cover Macular Degeneration?
Does Medicare Cover Mental Health?
Does Medicare Cover Mouth Guards for Sleep Apnea?
Does Medicare Cover Nuedexta?
Does Medicare Cover Ofev?
Does Medicare Cover Piqray?
Does Medicare Cover Scleral Lenses?
Does Medicare Cover Shock Wave Therapy for Plantar Fasciitis?
Does Medicare Cover TENS Units?
Does Medicare Cover Vitamins?
Does Medicare Pay for Funeral Expenses?
Does Medicare Require a Referral for Audiology Exams?
Estimating Prescription Drug Costs
Explaining IRMAA on Medicare
Explaining the Different Enrollment Periods for Medicare
Fair Square Client Newsletter: AEP Edition
Gap Health Insurance: The Secret Sidekick to Your High-Deductible Plan
Health Savings Accounts (HSAs) and Medicare
How Are Medicare Star Ratings Determined?
How Do I Sign up for Medicare? A Simple How-To Guide For You
How Do Medigap Premiums Vary?
How Much Does Medicare Cost?
How Much Does Open Heart Surgery Cost with Medicare?
How Much Does Trelegy Cost with Medicare?
How Much Does Xeljanz Cost with Medicare?
How to Deduct Medicare Expenses from Your Taxes
How to Enroll in Social Security
Is Emsella Covered by Medicare?
Is HIFU Covered by Medicare?
Is PAE Covered by Medicare?
Is the Shingles Vaccine Covered by Medicare?
Medicare & Ozempic
Medicare Advantage Plans for Disabled People Under 65
Medicare Deductibles Resetting in 2025
Medigap vs. Medicare Advantage
Seeing the Value in Fair Square
Should You Work With A Remote Medicare Agent?
The Easiest Call You'll Ever Make
Welcome to Fair Square's First Newsletter
What Are Medicare Part B Excess Charges?
What is a Medicare Beneficiary Ombudsman?
What is Plan J?
What People Don't Realize About Medicare
What To Do If Your Medicare Advantage Plan Is Discontinued
What to Do When Your Doctor Doesn't Take Medicare
What to Do When Your Doctor Leaves Your Network
What's the Difference Between HMO and PPO Plans?
When Can You Change Medicare Supplement Plans?
Why You Should Keep Your Medigap Plan
Get the Fair Square Bulletin
Medicare savings tips, helpful guides, and more.
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
Fair Square Medicare
