This bill revises Medicare law to recognize audiology services as a defined Part B benefit and to remove statutory barriers that have required physician referral or supervision for certain audiology diagnostic and treatment services. It gives qualified audiologists the ability to furnish and bill Medicare directly for services they are authorized to perform under state law.
The measure also changes how those services are paid and where audiologists can be treated within Medicare’s delivery system: it specifies a payment construct, allows audiologists to receive assignment-based payments, and explicitly lists them as practitioners for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). The combination of provider autonomy, new billing pathways, and payment rules will matter to clinicians, clinics, Medicare contractors, and beneficiaries with hearing and balance needs — and it will raise a set of operational and state-federal coordination questions for implementation.
At a Glance
What It Does
Adds ‘audiology services’ to the Medicare statutory benefit, permits qualified audiologists to furnish diagnostic and treatment services they are state-authorized to perform without physician referral or supervision, and allows assignment-based payment to audiologists. It also treats audiologists as eligible practitioners in RHCs and FQHCs. The bill takes effect for services furnished on or after January 1, 2027 and includes a rule limiting coverage expansion to services payable as of December 31, 2026.
Who It Affects
Medicare beneficiaries who need hearing or balance assessment and treatment, licensed audiologists seeking to bill Part B directly, RHCs and FQHCs that may add audiology to their service mix, and CMS and Medicare Administrative Contractors (MACs) that process claims and set local coverage policies.
Why It Matters
By removing statutory referral and supervision requirements and establishing direct payment pathways, the bill shifts where and how audiology care can be delivered and paid for under Medicare — expanding clinician autonomy but forcing operational, coding, and state scope-of-practice alignment decisions for payers and providers.
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What This Bill Actually Does
The bill rewrites Medicare benefit language so audiology services sit squarely inside the statutory list of Part B-covered items and services. That matters because statutory recognition creates a clear legal basis for payment and billing rules; the text ties coverage to the services a qualified audiologist is legally permitted to provide under state law.
In short: if state law authorizes an audiologist to perform a diagnostic or treatment service that otherwise would be covered when furnished by a physician, Medicare will recognize that service when furnished by the audiologist.
A central operational change is the removal of the statutory requirement that beneficiaries be under a physician’s care, be referred by a physician, or receive services under physician supervision. The effect is to allow qualified audiologists to initiate and furnish covered diagnostic and treatment services independently, subject to state scope-of-practice.
That will change referral patterns, increase the number of clinician types who can bill directly, and require updates to practitioners’ enrollment and credentialing with Medicare.On payment, the bill ties Medicare’s share to a fee schedule construct and explicitly authorizes assignment-based payment to audiologists. It directs that amounts paid for audiology services be 80% of the lesser of the actual charge or the fee schedule amount under the physician fee schedule framework — a formula that determines how much Medicare pays versus the beneficiary’s coinsurance.
Including audiologists as RHC/FQHC practitioners opens community clinics to provide and bill for audiology services under those program rules, but also triggers operational changes in billing and encounter reporting.The statute includes a rule of construction limiting the bill’s reach: it does not expand the universe of audiology services beyond those payable as of December 31, 2026. That cap narrows the bill’s ability to create new covered services; instead, it primarily shifts who may furnish existing covered services and how they are paid.
Implementing these changes will require CMS rulemaking, Medicare Administrative Contractor guidance, updated provider enrollment categories, and clear mapping of audiology codes to fee schedule values so claims process correctly on and after January 1, 2027.
The Five Things You Need to Know
The bill inserts a new subparagraph (KK) into 42 U.S.C. 1395x(s)(2) to designate ‘audiology services’ as a Part B item.
It amends 42 U.S.C. 1395x(ll)(3) to permit qualified audiologists to furnish diagnostic or treatment audiology services they are authorized to perform under state law without a physician referral or supervision, effective January 1, 2027.
It modifies payment language at 42 U.S.C. 1395l(a)(1) to require that Medicare pay 80% of the lesser of the actual charge or the fee schedule amount under section 1848 for audiology services.
The bill adds qualified audiologists to the list of providers eligible for assignment-based payment under 42 U.S.C. 1395u(b)(18)(C), enabling them to accept Medicare assignment.
It amends 42 U.S.C. 1395x(aa)(1)(B) to include qualified audiologists as practitioners for RHC and FQHC purposes, while explicitly limiting coverage to services payable as of December 31, 2026.
Section-by-Section Breakdown
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Statutory recognition of audiology services
This subsection adds ‘audiology services’ to the statutory list of Part B-covered services (inserted as new subparagraph (KK) into section 1861(s)(2)). That change is legal housekeeping with practical effect: it gives CMS an explicit statutory hook to create payment and coverage rules tied to audiology and removes ambiguity about whether such services belong in the Medicare benefit package.
Definition and removal of referral/supervision requirement
This is the substantive core: it rewrites the definition at section 1861(ll)(3) so that, beginning January 1, 2027, qualified audiologists may furnish diagnostic and treatment services they are legally authorized to perform under state law, ‘as would otherwise be covered if furnished by a physician or as incident to a physician’s service.’ Critically, it removes any statutory requirement that a beneficiary be under a physician’s care, be referred by one, or receive services under physician supervision. Practically, that transforms how audiologists enter the Medicare billing stream and alters referral and care pathways.
Payment formula for audiology services
This amendment adjusts Medicare’s payment provision to specify that amounts paid for audiology services will be 80% of the lesser of the actual charge or the fee schedule amount under section 1848. For claims processing this ties audiology payments to the fee schedule framework and clarifies Medicare’s share; it also fixes the statutory percentage that determines beneficiary coinsurance exposure unless other program rules apply.
Assignment payments and RHC/FQHC practitioner status
The bill adds qualified audiologists to the list of providers who may receive assignment-based payments, allowing audiologists to accept Medicare’s approved amount as full payment and bill beneficiaries only for permitted cost-sharing. It also inserts audiologists into the statutory practitioner lists for RHCs and FQHCs, thereby enabling those community clinics to incorporate audiology services into their Medicare-covered service offerings. Both changes will require updates to provider enrollment types and encounter reporting.
Limits on scope expansion and effective date
The statute includes a rule of construction that explicitly prevents the amendments from being read to expand the types of audiology services payable under Medicare beyond what was payable on December 31, 2026. The amendments apply to services furnished on or after January 1, 2027. That combination means the bill mainly alters who can furnish and bill for existing payable services rather than creating new covered procedures.
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Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Medicare beneficiaries with hearing and balance needs — they may gain more direct access to audiology care without needing a physician referral or supervision, potentially shortening time to diagnosis and treatment.
- Licensed audiologists — the bill clears a statutory pathway for direct billing and assignment-based payment, expanding revenue streams and clinical autonomy subject to state authorization.
- Rural Health Clinics and Federally Qualified Health Centers — by being able to count audiologists as eligible practitioners, these centers can add audiology services to their Medicare-covered offerings, improving local access.
- Small and independent audiology practices — they gain clearer Medicare billing authority and the option to accept assignment, which can stabilize reimbursement and patient collections.
Who Bears the Cost
- Medicare program and taxpayers — expanded use of audiology services and broader provider billing may increase program utilization and administrative costs, depending on demand and fee schedule valuation.
- Medicare beneficiaries’ out-of-pocket costs — the statutory payment rule setting Medicare’s share at 80% of the lesser of charge or fee schedule amount preserves a 20% coinsurance liability that beneficiaries (or supplemental plans) must cover.
- CMS and Medicare Administrative Contractors — they will bear operational and systems costs to create new claim edits, fee schedule entries, local coverage determinations, and provider enrollment pathways.
- State regulators and licensing boards — states will face pressure to align scope-of-practice and licensure rules with federal billing realities, which may require rulemaking or administrative action.
Key Issues
The Core Tension
The central dilemma is between expanding direct access to audiology care and preserving clinical oversight and Medicare cost controls: the bill removes physician referral and supervision barriers to improve access and clinician autonomy, but it pairs that expansion with a payment cap and a rule limiting the universe of payable services — forcing trade-offs between access, fiscal exposure, and the need for coordinated state-federal implementation.
The bill balances provider autonomy against a statutory cap on what Medicare will pay by tying coverage to services payable as of December 31, 2026. That cap reduces the risk that the statute becomes a vehicle for creating new benefit entitlements but also risks undercutting the legislative purpose if essential audiology services fall outside the pre-2027 payable list.
Implementation will hinge on CMS decisions: mapping audiology CPT/HCPCS codes to a fee schedule, determining how deductible and coinsurance apply in practice, and updating MAC edits so claims submitted by audiologists route correctly.
Operationally, the removal of referral and supervision language does not erase state scope-of-practice limits — an audiologist cannot bill Medicare for a service they are not legally authorized to perform in their state. The interaction between federal payment authorization and state licensing creates potential cross-jurisdictional complexity: providers in permissive states can take advantage of the change sooner and more fully than providers in restrictive states.
Finally, the bill’s payment formula leaves open questions about how CMS will set fee schedule amounts for audiology services and whether those amounts will be set to reflect existing utilization patterns, potential demand shifts, or cost-containment goals; those choices will materially affect provider behavior and beneficiary cost-sharing.
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