American Speech-Language-Hearing Association
November 4, 2010

CMS Issues 2011 Medicare Physician Fee Schedule with Audiology PQRI Incentive Payments

On Tuesday, November 2, 2010, the Centers for Medicare and Medicaid Services (CMS) released the final rule for the 2011 Medicare Physician Fee Schedule (MPFS). Each year CMS establishes a conversion factor (CF) that is used as a multiplier of the total relative value units (RVUs) for each procedure. The current CF is $36.8729. Unless Congress acts, the CF is scheduled to be reduced to $28.4061, effective December 1, 2010, and $25.5217, effective January 1, 2011. This would represent about a 30 percent reduction from current payments and would affect all payments under the physician fee schedule. These reductions are due to the application of a statutory formula known as the Sustainable Growth Rate. Please note that there is every indication that Congress will enact legislation to prevent these reductions from occurring.

CPT 2011 Rates (w/o Congressional Action) Current 2010 Rates (thru 11/30) % Rate Change
92540 Basic vestibular evaluation $72.99 $96.98 -24.73%
92557 Comprehensive hearing test $30.37 $41.30 -26.46%


CMS will continue the current audiology Physician Quality Reporting Initiative (PQRI) measures through 2011. The three audiology measures are referral for otologic evaluation for patients with: congenital or traumatic deformity of the ear; history of active drainage from the ear within the previous 90 days; and a history of sudden or rapidly progressive hearing loss.

For 2010, the incentive payment for satisfactorily reporting on measures is 2% of all allowable Medicare charges. The final rule affirms the incentive payment structure set out in the Affordable Care Act (ACA): an incentive payment of 1% for 2011 and .5% for 2012-2014. Starting in 2015, eligible professionals that do not satisfactorily report on quality measures will be subject to a payment adjustment.

The audiology measures are reported via claims. Currently, providers participating in PQRI need to report on 80% of patients that fit into a measure. Effective January 1, 2011, providers reporting on claims-based measures will only need to report on 50% of patients that fit into a measure.

Also of interest to audiologists is mention of screening of hearing impairment in older adults as part of the Health Risk Assessment of the Medicare Annual Wellness visit (AWV). CMS notes that the United States Preventive Services Task Force is updating its 1996 recommendation regarding screening for hearing impairment in older adults. Consequently, until those recommendations are published, functional status screenings are found by CMS to be "...supportable by evidence only for the first AWV."

Any comments or questions should be addressed to reimbursement@asha.org.


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