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The reimbursement rate for all new procedures is derived from the Medicare Physician Fee Schedule. Currently, the valuation of most audiology procedure codes is based primarily on practice expense rather than on physician work. Practice expense is the actual time spent by the non-physician provider to perform the service. This time is then multiplied by the average salary cost per minute. Along with the clinical staff time, the value of equipment, supplies, and overhead are included in the formula for practice expense.
If codes are valued based primarily on physician work, then other factors such as technical skill, judgment, and psychological stress are incorporated into the valuation formula. When a procedure involves physician work as opposed to practice expense, it is typically more generously valued and, therefore, reimbursed at a higher level. ASHA continues to have discussions with CMS about the possibility of moving audiology and speech-language pathology services from practice expense to "work." This would be comparable to the valuation now afforded physical therapy and occupational therapy services. While ASHA is actively working to achieve this change, the ultimate resolution is still very much uncertain. However, you may be assured that improving payment for audiology and services is the highest priority of the ASHA HCEC.
For questions or comments about this column, contact reimbursement@asha.org.
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