Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness
Percentage of patients aged birth and older referred to a physician (preferably a physician specially trained in disorders of the ear) for an otologic evaluation subsequent to an audiologic evaluation after presenting with acute or chronic dizziness.
Last updated: January 15, 2026
🧮MIPS Score Simulator
Estimate only — actual CMS scoring may vary based on reporting method, data completeness, and annual rule updates.
📖Clinical Rationale
Studies demonstrate that patients who present with acute or chronic dizziness may suffer from underlying problems, so therefore referral is necessary. Without referral, patients may suffer consequences of the underlying problems.
📝Clinical Recommendations
The American Academy of Otolaryngology-Head and Neck Surgery policy statement (approved 9/12/2002): Hearing loss and balance disorders are medical conditions. Only licensed physicians with medical training may diagnose and direct the management of disease and medical disorders. A full history and physical examination by a physician (preferably a physician specially trained in disorders of the ear) to determine the accurate medical diagnosis and appropriate medical/surgical treatment for hearing loss and balance disorders are indicated for patients with the following “red flags”: 1) Hearing loss with a positive history of familial hearing loss, TB, syphilis, HIV, Meniere’s disease, autoimmune disorder, otosclerosis, von Recklinghausen’s neurofibromatosis, Paget’s disease of bone, head trauma related to onset.
2) History of pain, active drainage, or bleeding from an ear. 3) Sudden onset or rapidly progressive hearing loss. 4) Acute, chronic, or recurrent episodes of dizziness. 5) Evidence of congenital or traumatic deformity of the ear. 6) Visualization of blood, pus, cerumen plug, or foreign body in the ear canal. 7) Conductive hearing loss or abnormal tympanogram.
8) Unilateral or asymmetric hearing loss; or bilateral hearing loss > 80 dB. 9) Unilateral or pulsatile tinnitus. 10) Unilateral or asymmetrically poor speech discrimination scores. The red flags do not include all indications for a medical referral and are not intended to replace clinical judgment in determining the need for consultation with an otolaryngologist.
21 C.F.R. Section 801.420: A hearing aid dispenser should advise a prospective hearing aid user to consult promptly with a licensed physician (preferably an ear specialist) before dispensing a hearing aid if the hearing aid dispenser determines through inquiry, actual observation, or review of any other available information concerning the prospective user, that the prospective user has any of the following conditions: 1) Visible congenital or traumatic deformity of the ear.
2) History of active drainage from the ear within the previous 90 days. 3) History of sudden or rapidly progressive hearing loss within the previous 90 days. 4) Acute or chronic dizziness. 5) Unilateral hearing loss of sudden or recent onset within the previous 90 days. 6) Audiometric air-bone gap equal to or greater than 15 decibels at 500 hertz (Hz), 1,000 Hz, and 2,000 Hz.
7) Visible evidence of significant cerumen accumulation or a foreign body in the ear canal. 8) Pain or discomfort in the ear.
📋Implementation Notes
This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient for the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.
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