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The Centers for Medicare and Medicaid Services (CMS) recently announced the 2007 rates for services in hospital-based outpatient departments. The Medicare hospital Outpatient Prospective Payment System (OPPS) establishes payment rates for all outpatient hospital audiology services. Speech-language pathology, physical therapy, and occupational therapy are paid under the Medicare Physician Fee Schedule. The rates are based on 2005 nationwide hospital cost data.
In response to ASHA's advocacy, two audiology procedures - central auditory function (CPT 92620) and tinnitus assessment (CPT 92625) - are scheduled for rate increases of almost 300 percent from $27.07 to $76.74 because of shifts to a different Ambulatory Payment Classification (APC) - from Level I Audiometry to Level II Audiometry. ASHA submitted detailed arguments to CMS, regarding the low payment for these two evaluation procedures.
Other audiology rate changes include:
- Auditory evoked potentials; Visual evoked potentials: + 11.3%
- Audiometric tests: + 5.1 to 7.5%
- Vestibular function; Evoked emissions, limited: + 1.1%
- Posturography; Evoked emissions, comprehensive: - 4.6%
ASHA was also responsible for the addition of a new CPT code 92640 - Auditory Brainstem Implant programming. Because this is a new code, the rate cannot be based on historic costs. CMS assigned the code to APC 365, Level II Audiometry ($76.34). ASHA will examine alternative pricing and, if a better rate is justifiable, may submit comments to CMS in early 2007.
The new rate for cochlear implantation, which covers both the surgery and device, has been set at $25,500 or an 8.8% increase. While this rate remains less than the full costs incurred by hospitals, it is a substantial improvement over the 2006 rate.
The 2007 OPPS final rule can found at http://www.cms.hhs.gov/HospitalOutpatientPPS/HORD/list.asp and clicking on item CMS-1506-FC. For further information, please contact Mark Kander, ASHA's Director of Health Care Regulatory Analysis, via e-mail at mkander@asha.org or by phone at 800-498-2071, ext. 4139.
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