American Speech-Language-Hearing Association

CMS Releases Proposed Medicare Outpatient Hospital and Ambulatory Surgical Centers Rates for 2014

(July 26, 2013)

The Centers for Medicare and Medicaid Services (CMS) has released proposed regulations for Medicare Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems for 2014. The 718-page proposal includes

  • rates for hospital outpatient audiology, vestibular, and intraoperative monitoring services;
  • physician-only services for outpatient hospital and ambulatory surgical centers;
  • revisions to rate-setting methodology.

Currently, ASHA is analyzing the proposed regulations in order to prepare and submit comments to CMS by the September 6, 2013, due date. It is likely critical comments will be limited to cochlear implantation, because ASHA supports the regulations' advantageous rate increases for other audiology-related procedures.

Hospital Outpatient Rates

For 2014, most of the audiology-related procedures show proposed significant increases. Each of the first three bulleted items below represents two or more payment groups.

  • Audiology diagnostic tests: +14–66%
  • Vestibular tests: +66–363%
  • Intraoperative testing: +53%–69%

Physician-only codes

  • Remove impacted cerumen: +52%
  • Cochlear implantation: -1.3%
  • Osseointegrated implantation: +5%

Annual shifts in hospital outpatient prospective payment system (OPPS) rates are based primarily on national hospital cost records. For 2014, certain changes in hospital Medicare cost reporting were initiated by CMS in the past and are now in effect for OPPS. Additionally, a new application, known as conditional packaging, applies to each payment group where there are audiology diagnostic and certain other procedures. An inflation factor (1.8%) also affects 2014 rates.

Ambulatory Surgical Center Rates

Physician-only codes

  • Cochlear implantation: -0.02%
  • Osseointegrated implantation: +3.6%

Background

The rates for most hospital outpatient services, including audiology, are determined under the hospital OPPS based on the assignment of CPT procedures to ambulatory payment classifications (APCs). APCs comprise procedures that are comparable, clinically and with respect to resource use. Outpatient hospital rates for speech-language pathology-like physical therapy and occupational therapy-are determined by the Part B Medicare Physician Fee Schedule. Ambulatory surgical facilities render more limited services but are intended to be more convenient and less costly to owners and patients.

Resources

For further information, see the July 29, 2013, Federal Register [PDF] or contact Mark Kander, ASHA's director of health care regulatory analysis, at mkander@asha.org or 800-498-2071, ext. 5669.


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