[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-170217-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-170217-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","audiology-superbill-template","Audiology Superbill Template","","Editable audiology superbill template for capturing key patient demographics, dates of service, payer information, provider and billing fields, and summarized coding support. Includes commonly reported audiology CPT procedure codes, vestibular procedure sections, modifiers, virtual-only service indicators, and HCPCS codes for hearing aids and supplies. Provides ICD-10 diagnosis code list and Medicare modifier cues, along with structured MIPS measure documentation requirements, CPT/ICD-10 mappings, and code-specific notes for measure #130, #134, #155, #181, and #182.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/invoices/","Invoices",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/audiology-superbill-template/170217/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/audiology-superbill-template/170217.png","ImageObject",442,249,{"name":42,"@type":43},"วิน","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/vnd.openxmlformats-officedocument.wordprocessingml.document","2026-10-07","2026-09-01",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",5,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What patient and billing details does the superbill template include?","Question",{"text":63,"@type":64},"The template captures patient name, date of birth, date of service, primary and secondary insurance, audiologist information, and fields for commonly billed codes plus financial entries such as current fees, payment amount, balance, and next appointment.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Which code sets are referenced in the template?",{"text":68,"@type":64},"It lists commonly reported CPT procedure codes, commonly reported HCPCS codes for hearing aids/supplies and procedures, and commonly reported ICD-10 diagnosis codes. Medicare modifiers and common modifiers are also included for billing support.",{"name":70,"@type":61,"acceptedAnswer":71},"How does the template support MIPS reporting?",{"text":72,"@type":64},"It provides MIPS measure guidance with measure numbers and associated CPT and ICD-10 applicability, including documentation expectations and specific code options that reflect performance outcomes and required supporting details.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},170217,1790289391,{"code":4,"msg":82,"data":83},"success",[84,89,94,98,103,108,113,118,122],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":96,"slug":97},14,70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":110,"show_sort_weight":111,"slug":112},17,"Forms",40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":115,"show_sort_weight":116,"slug":117},18,"Letters",30,"letters",{"id":119,"doc_module":22,"doc_module_name":25,"category_name":120,"show_sort_weight":55,"slug":121},21,"Paper Templates","papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":82,"data":127},{"doc_id":79,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":95,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":135,"language":136,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":12,"update_tm":140,"read_time":30},2336475104736,"https://ap-avatar.wpscdn.com/avatar/22000c4c5e0e5b17e70?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786591360781797222","PATIENT NAME\t\t\t\t\tDATE OF BIRTH\t\t\t\tDATE OF SERVICE\nPRIMARY INSURANCE\t\t\t\tSECONDARY INSURANCE\t\t\tAUDIOLOGIST\nCOMMONLY REPORTED CPT CODES (PROCEDURE CODES) CPT ® Copyright 2024 American Medical Association. All rights reserved.\nAUDIOLOGY PROCEDURES\nVESTIBULAR PROCEDURES\nCOMMON MODIFIERS\nVIRTUAL- ONLY SERVICES\nCOMMONLY REPORTED HCPCS CODES (Hearing aids/supplies/several procedures)\nMEDICARE MODIFIERS\n COPAY           INSURANCE      \t CASH           CREDIT CARD           CHECK #\n________________________________________________________________________________________________________________\nCURRENT FEES: \t\t\t\t\t\tPAYMENT AMOUNT:\n_________________________________________________________________________________________________________________\nBALANCE: \t\t\t\t\t\t\tNEXT APPOINTMENT:\nDisclaimer: The purpose of the information provided above by the American Academy of Audiology Coding and Reimbursement Committee is to provide general information and educational guidance to audiologists. Action taken with respect to the information provided is an individual choice. The American Academy of Audiology hereby disclaims any responsibility for the consequences of any action(s) taken by any individual(s) as a result of using the information provided, and reader agrees not to take action against, or seek to hold, or hold liable, the American Academy of Audiology for the reader's use of the information provided. As used herein, the \"American Academy of Audiology\" shall be defined to include its directors, officers, employees, volunteers, members and agents.\nCommonly Reported ICD-10 Codes (Disease/Diagnosis Codes)\nH90 Conductive and Sensorineural Hearing Loss\nH91 Other and unspecified hearing loss\nOther abnormal auditory perceptions\nTinnitus\nOther diseases of inner ear\nCerumen\nOtitis Media\nDisorders of vestibular function\nDizziness, auditory hallucinations and abnormal results\nFactors influencing health status and contact with health services:\nZ codes are supplemental codes and represent reasons for an encounter and must be reported with a procedure, if performed.\nCodes for Merit-based Incentive Payment System (MIPS) Quality Measures Reporting\n* Performance Not Met (use of this code will not count for successful reporting of quaity measures as required by MIPS)\n*For detailed measure specifications, see: \u0013 HYPERLINK \"about:blank\" \u0014QPP Resource Library (cms.gov)\u0015.  You are encouraged to read the entire measure specification for each measure you elect to report on.\nMeasure #130:  Documentation and Verification of Current Medications in the Medical Record\nCPT Codes: 92537, 92538, 92540, 92541, 92542, 92544, 92545, 92548, 92550, 92557, 92567, 92568, 92570, 92588, 92626;\nICD-10:  Applies to all ICD-10 codes.\nG8427\tList of current medications documented by provider, including drug name, dosage, frequency, and route\nG8430\tProvider documentation that patient is not eligible for medication assessment\nG8428*\tCurrent medications with drug name, dosage, frequency, and route not documented by provider; reason not specified\nMeasure #134: Preventative Care and Screening: Screening for Clinical Depression and Follow-up Plan\nCPT Codes: 92625; ICD-10:  Applies to all ICD-10 codes.  Applies to patients 12 years and older.\nG9717\tDocumentation stating patient has active diagnosis of depression or has diagnosed bipolar disorder, screening not required\nG8431\tPositive screen for clinical depression using an age appropriate standardized tool and a follow-up plan documented\nG8510\tNegative screen for clinical depression using an age appropriate standardized tool, follow-up not required\nG8433\tScreening for clinical depression using an age appropriate standardized tool not documented, patient not eligible/ refuses to participate\nG8432*\tNo documentation of clinical depression screening using an age appropriate standardized tool\nG8511*\tPositive screen for clinical depression using an age appropriate standardized tool documented, follow-up plan not documented; reason not specified\nMeasu","cbCaikWhpgN8yGo9","https://ap.wps.com/l/cbCaikWhpgN8yGo9","docx",91528,7,"English","# Patient and Service Information\n## Insurance, Provider, and Billing Fields\n# Coding Reference\n## Commonly Reported CPT Procedure Codes\n## Vestibular Procedures and Modifiers\n## Commonly Reported HCPCS Codes\n## ICD-10 Diagnosis Codes\n# MIPS Quality Measures\n## Measure #130 Documentation and Verification of Current Medications\n## Measure #134 Depression Screening and Follow-up Plan\n## Measure #155 Falls Plan of Care\n## Measure #181 Elder Maltreatment Screen and Follow-up Plan\n## Measure #182 Functional Outcomes Assessment","[{\"question\":\"What patient and billing details does the superbill template include?\",\"answer\":\"The template captures patient name, date of birth, date of service, primary and secondary insurance, audiologist information, and fields for commonly billed codes plus financial entries such as current fees, payment amount, balance, and next appointment.\"},{\"question\":\"Which code sets are referenced in the template?\",\"answer\":\"It lists commonly reported CPT procedure codes, commonly reported HCPCS codes for hearing aids/supplies and procedures, and commonly reported ICD-10 diagnosis codes. Medicare modifiers and common modifiers are also included for billing support.\"},{\"question\":\"How does the template support MIPS reporting?\",\"answer\":\"It provides MIPS measure guidance with measure numbers and associated CPT and ICD-10 applicability, including documentation expectations and specific code options that reflect performance outcomes and required supporting details.\"}]","Audiology Superbill Template | DOCX",1788269140]