Audiology Billing Services
Specialized audiology billing & RCM accurate coding for diagnostic audiometry, hearing aids, cochlear implants and balance testing, fewer denials, and AI-powered workflows built for hearing care providers.
You help people hear better. We make sure you’re paid for it. Audiology billing is rules-heavy from CPT 92557 audiological evaluations to HCPCS V-codes for hearing aid services and one small coding mistake can delay revenue or trigger audit headaches. At Sirius Solutions Global, we combine audiology-savvy coders, payer-by-payer templates, and AI-assisted scrubbing to protect your revenue so your team can focus on patient outcomes.
Full-cycle audiology revenue cycle management
We treat audiology like the specialty it is. Our services are designed to stop revenue leakage at every point from scheduling to reconciliation.
Front door: Eligibility & benefit checks
-
Real-time insurance verification at scheduling and check-in (including Medicaid/state plans and private hearing-aid benefits).
-
Identify whether the payer covers diagnostic testing, hearing aid fittings, cochlear implant programming, or only partial services and flag items that need prior authorization.
Accurate coding & charge capture
-
Specialist coders handle the common audiology CPTs (e.g., 92557, 92552, 92553, 92555, 92590 series where applicable) and HCPCS V-codes for hearing aid services. We map clinical notes to the correct codes and ensure modifier usage is precise (no “one-size” coding).
Hearing aid & device billing
-
Hearing aids themselves are often outside traditional Medicare coverage, but many commercial plans or state programs cover hearing aid services we know when to submit V-codes, when to secure a payer denial (so secondary payer will pay), and how to document fittings and assistive device services correctly.
Claims submission & payer templates
-
We submit electronic claims with payer-specific templates (POS, rendering provider taxonomy, device supplier numbers) to reduce rejections. When payers require attachments (notes, technician logs), we include them at submission.
Denial management & appeals
-
We cluster denials by cause, fix root causes (template updates, staff training), and pursue tailored appeals with documentation. Common denials in audiology include coverage exclusions for hearing aids, missing physician orders where required, and incorrect use of HCPCS vs CPT.
Patient billing & collections
-
Clear patient statements (audiology patients often face device OOP costs). We offer transparent payment plans and friendly financial counselling to protect patient relationships while collecting balances.
KPI reporting & continuous improvement
-
Weekly dashboards: clean claim rate, denial rate by payer/code, days in A/R, average reimbursement per visit, hearing-aid device recovery. Monthly action plans list the top three fixes and who owns each.
Outcomes audiology practices typically see
-
Higher first-pass acceptance (fewer edits/denials) via payer templates and AI scrubbing.
-
Faster reimbursement & improved cashflow because high-risk claims are corrected pre-submission.
-
Fewer audit surprises because documentation bundles are attached proactively.
-
Better patient payment rates due to clear statements and flexible payment options for device costs.
-
Realistic ROI: most clinics recover onboarding costs within 60–120 days, especially when device/durable revenue is significant.
Why audiology billing needs a specialist
Audiology is deceptively complex for billing teams used to general outpatient care:
-
Diagnostic services and hearing evaluations (e.g., CPT 92557) have unique documentation expectations and are sometimes confused with technician vs professional components.
-
Hearing-aid related services often use HCPCS V-codes (V5010, V5011, V5020 etc.) and carry different payer rules some payers cover certain fitting/assessment services, others do not; Medicare traditionally excludes hearing aids themselves but covers diagnostic audiology in some scenarios.
-
State programs and Medicaid have their own rules (e.g., newborn screening billing restrictions and coverage specifics). Knowing these prevents rejected claims.
-
The vendor/competitive landscape includes specialty RCM vendors focused on audiology and larger RCM firms that have audiology teams practices choose vendors for domain expertise, integration depth, and denials performance.
Takeaway: Audiology billing benefits most from a partner that understands CPT/HCPCS nuance, payer variability, and can operationalize that knowledge into rule-based + AI workflows.
Common audiology billing challenges & how we fix them
-
Problem: CPT 92557 miscoding clinicians and staff sometimes confuse technical vs professional elements.
Fix: We provide EHR templates and coder checks to ensure documentation supports the code and that the claim uses the proper provider NPI. -
Problem: Hearing aid device denied because of Medicare exclusion many practices try to bill devices to Medicare directly.
Fix: We identify the right payer sequence and where necessary secure a required denial to allow secondary coverage to be billed, or advise on point-of-sale options and patient financial arrangements. -
Problem: Newborn hearing screen billed incorrectly during delivery stay.
Fix: We apply state rules (newborn hearing screening often bundled into delivery DRG) and block claims for covered dates to avoid denied items. -
Problem: Hearing aid follow-up/check billed separately but payer expects it bundled.
Fix: Payer-specific templates and pre-auth validation prevent common bundling errors; our A/R team follows up only when the payer says a separate charge is allowed.
How our AI-Powered Billing helps audiology practices
You asked for specifics. Here’s how we apply AI to produce measurable benefits:
-
Claim risk scoring — ML models analyze historical denials and flag high-risk claims pre-submission. Human coders review only the high-risk set, saving time while reducing denials.
-
Automated code suggestions from clinical notes — NLP extracts keywords (e.g., “arthroscopy,” “meniscectomy,” “therapy minutes”) and proposes CPTs/modifiers to speed coder workflow and reduce miscoding.
-
Predictive A/R prioritization — AI ranks outstanding accounts by expected recoverable value and probability of success so billers focus on the dollar-impact cases first.
-
Dynamic payer rules engine — an automated monitor ingests payer bulletins and updates scrubbing rules so your claims reflect the latest policy without manual lag.
-
Denial clustering & root-cause automation — the system groups denials by pattern (same CPT/payer/provider), auto-generates remediation steps, and tracks corrective action until the trend is fixed.
Bottom line: AI reduces repetitive work, surfaces the exceptions, and lets experienced billers apply their judgment where it matters most.
Quick Helpful Answers
- 01
- 02
- 03
- 04
- 05
Ready to optimize your collections
If billing is taking time away from patient care and slowing your cashflow, let’s fix it.
Request your free Audiology Billing Audit we’ll review your claims, identify the top 5 denial drivers, and deliver a prioritized action plan with quick wins you can implement immediately.