American Speech-Language-Hearing Association

CMS Releases Medicare Fee Schedule for 2013

(November 2, 2012)

On November 1, 2012, the Centers for Medicare and Medicaid Services (CMS) released the final Medicare Physician Fee Schedule (MPFS) and associated rules [PDF, 3.5MB] for 2013. The 1,362-page document includes regulations and rates for implementation on January 1, 2013, for audiologists and speech-language pathologists providing services to Medicare Part B beneficiaries under the MPFS. Key policies addressed in the final rule include the process for reporting therapy outcomes on the claim form (page 219), the Physician Quality Reporting System (PQRS; Table 95, page 983), and new requirements for Speech-Generating Devices (SGD; page 763).

Medicare Physician Fee Schedule Summary

  • Payment Rates: CMS established a conversion factor (CF) of $25.0008, which represents a 26.5% decrease from current payments and would affect all payments under the MPFS. Please note that, although the reduction is mandatory, Congress has taken action to prevent similar reductions almost every year since initiation of the Sustainable Growth Rate.
  • Reporting of Therapy Claims: CMS will implement a claims-based data collection strategy for reporting patient conditions and outcomes for therapy services. As part of this data collection strategy, CMS has adopted seven of ASHA's National Outcomes Measurement System (NOMS) Functional Communication Measures (FCMs) for purposes of reporting on the claim form with non-payable G-codes and a 7-point severity modifier at admission, on every 10th treatment day, and at discharge of the therapy plan.
  • Therapy Caps: The final rule reiterated that the current exceptions process for the therapy cap will expire on December 31, 2012, absent Congressional action. For 2013, CMS has calculated that the therapy cap will increase from $1,880 to $1,900. Visit ASHA's Take Action website to tell your members of Congress to allow the exceptions process to continue in 2013.
  • Speech-Generating Devices: Four SGDs remain on the list of Durable Medical Equipment (DME) that requires documentation of a face-to-face encounter with the physician, nurse practitioner, or physician's assistant no more than 6 months prior to the written order for the SGD.
  • Physician Quality Reporting System: Reporting for audiology and speech-language pathology through the PQRS will continue with four audiology-specific measures reported on the claim form and eight speech-language pathology FCMs reported through NOMS. Reporting is still required in 2013 to avoid the penalty assessed on 2015 claims.

ASHA Resources

Further analysis is still being conducted and will be available on ASHA's billing & rimbursement website, in future articles in The ASHA Leader, and through ASHA Headlines. Questions may be directed to reimbursement@asha.org.


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