American Speech-Language-Hearing Association
November 8, 2010

Audiology Services – CMS Issues 2011 Medicare Outpatient Hospital Rates

The Centers for Medicare and Medicaid Services (CMS) released rates on November 2, 2010, for services in hospital-based outpatient departments in 2011. The Medicare Hospital Outpatient Prospective Payment System (OPPS) establishes payment rates for most services except speech-language pathology, physical therapy, and occupational therapy. Therapy services are paid under the Medicare Physician Fee Schedule.

Following is a summary of audiology rate changes:

  • Cochlear implant follow-up/reprogramming +13.7%
  • Evaluation of auditory rehabilitation status +13.7%
  • Stenger test; Spondaic word test +13.7%
  • Basic vestibular evaluation (bundled) +0%
  • Independent vestibular function tests +0 – 3.5%.
  • Comprehensive ABR and Electrocochleography +2.9%
  • EOE, comprehensive and limited +0% and 3.5%, respectively
  • Other audiometric tests +2.4 - 3.5%

Cochlear Implantation 

CMS has increased the payment level from $28,906 to $31,060, an increase of 7.4%. The payment is intended to cover the device and non-physician surgical costs. Audiologists and others involved with cochlear implants are pleased that the 2011 rate will help retain hospital centers that offer this service.

Auditory Osseointegrated Devices (Baha) 

The payment has been increased to $8,596, a 7.4% enhancement. This level is in contrast to a $7,068 for ambulatory surgical centers (ASCs). ASHA has emphasized to CMS that the rate for this implant should be increased in ASCs in order to cover the facility costs and attract more cases to this setting with superior cost efficiencies.

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