Pediatric Audiology

Tel: (800) 995-5724 

You can register for Stanford Medicine Children's Health MD Portal (https://mdportal.stanfordchildrens.org) to submit referrals and track appointments online.

* Required

Referring Provider

Referring to Pediatric Audiology

In order to schedule a patient in Pediatric Audiology the insurance authorization (if required by the insurance) must be in place for the required procedure CPT codes (see list).

Note: Please refer patients for speech delays and failed hearing screenings to Audiology first. Referring to ENT first may delay the patient having a diagnostic hearing evaluation.

Procedure Requested
(Stanford Children’s Health Audiology performs Diagnostic Testing)

* ICD10 (Required)

HMO or a Managed Care Medical patients require the following procedure CPT codes to be authorized from the patient’s insurance according to their age group:

Please reference above CPT codes for different age groups to ensure authorization covers each CPT code.

Required Patient Information
Insurance Information
Document Upload

Please attach the following documents:

  • All relevant clinical documents (i.e. clinic notes, history and progress notes, medication history, growth charts-height and weight, head circumference, labs, diagnostic reports and a copy of the insurance card)
  • Remember to attach authorization.
  • A legible copy of the insurance card (both sides), and authorization if required.

Upload File (up to 30 files):


Attached Files