ASHA’s Analysis of 2018 Medicare Payment Policies for Outpatient Audiology and Speech-Language Pathology Services

December 5, 2017

ASHA's analysis of the 2018 outpatient Medicare Physician Fee Schedule (MPFS) and hospital Outpatient Prospective Payment System (OPPS) final rules for audiologists and speech-language pathologists are now available on the billing and reimbursement website. These documents provide an overview of relevant policy changes and calculate national average payment amounts for audiology and speech-language pathology services.

Medicare Physician Fee Schedule

Key policies addressed include new coding for cognitive treatment, new modifiers to report patient relationship categories, and payment adjustments under the Physician Quality Reporting System (PQRS). National payment rates for audiology and speech-language pathology services are also provided.

The Centers for Medicare & Medicaid Services (CMS) released a 2018 conversion factor (CF) of $35.9996, which is slightly higher than the 2017 CF of $35.8887. The conversion factor is multiplied by the total relative value units (which are adjusted for geographical differences) to determine the corresponding fee.

The 2018 therapy cap is $2,010 for speech-language pathology and physical therapy services combined. Congressional action is needed before 2018 to extend the exceptions process and avoid a hard cap.

Hospital Outpatient Prospective Payment System

Key policies addressed in the OPPS analysis include a change in payment for caloric vestibular testing and site neutral payment. Ambulatory Payment Classifications (APCs) and associated rates for audiology and some speech-language pathology services are also provided.

CMS is updating OPPS rates by 1.35% and estimates that hospital outpatient departments will see a 1.4% increase in payments, after the impact of all other policy changes are taken into consideration.

Background

Audiology and speech-language pathology services under Medicare Part B (outpatient) have reimbursement rates established by the MPFS. Most speech-language pathology services provided in hospital outpatient settings are also based on the MPFS, whereas audiology outpatient hospital services are paid under the hospital OPPS.

ASHA Resources

Questions?

Please email reimbursement@asha.org with questions regarding the MFPS or hospital OPPS. 


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