Medicare Denials of AB Modifier
Kim Cavitt, Au.D.
ADA is aware of the Medicare denials associated with the AB modifier. This was expected.
Medicare clearly indicated, in the Final Rule, that implementation of this modifier may be slow. They stated:
“Aligning our final policy to use modifier AB…necessitates multiple changes to our claims processing systems, which will take some time to operationalize, possibly until mid-year 2023. Until such time, audiologists may use the AB modifier that is available for dates of service on and after January 1, 2023, to provide services/tests to beneficiaries who have directly accessed their services. Audiologists who furnish these services without an order are expected to follow our policy and safeguards built into the AB modifier, as above and in the code descriptor below. As we noted above, we plan to communicate to audiologists via provider education and other guidance, including the Audiology Services webpage page at https://www. cms.gov/audiology-services”.
Please note that Medicare does document the AB modifier on their Audiology Services page. This documentation can be used in any appeal.
Practices have options available to them to manage this situation. All options have pros and cons. It is recommended that each practice select the option that is the most efficient and cost effective for their practice and patients. The options are:
- Continue to get physician orders, for all traditional Medicare beneficiaries, until April-June 2023,
- Hold Medicare claims that include the AB modifier until April-June 2023 (Medicare allows 365 days to submit claims) or
- Use the information above to appeal claims denials.
ADA offers member resources on implementation of the 2023 Medicare Physician Order changes and AB modifier:
Please do not hesitate to contact Kim Cavitt at
Dr. Kim Cavitt was a clinical audiologist and preceptor at The Ohio State University and Northwestern University for the first ten years of her career. Since 2001, Dr. Cavitt has operated her own Audiology consulting firm, Audiology Resources, Inc. She currently serves on the State of Illinois Speech Pathology and Audiology Licensure Board. She also serves on committees through AAA and ASHA and is an Adjunct Lecturer at Northwestern University.