Bill,

Here's a sample local coverage determination for earwax removal:

http://www.mediquant.com/policy/L33945_20151001.pdf

Note that there are guidelines as to when a physician's skill is needed rather than a nurse or technician, but also see this:

>>It is recognized that audiologists' education, experience or practice may include or require techniques of cerumen removal. However, Medicare can pay audiologists only for medically necessary diagnostic testing, which is considered to include any incidental cerumen removal by the audiologist. Medicare cannot reimburse audiologists for CPT code 69210 or HCPCS code G0268 under any circumstances.

In other words, the audiologist does not get paid a bean extra for performing earwax extraction. You blame physicians for this, but it's a Medicare policy. On the same topic- physicians can't claim extra above their standard E/M fee unless certain criteria are met. Certainly "routine" earwax extraction would not be regarded by Medicare as meeting the criteria.