September 1, 2013 Departments

Policy Analysis: Proposal Boosts Medicare Audiology Outpatient Hospital Rates

Rates for services provided by audiologists in hospital outpatient centers would increase substantially in 2014 under a proposed Medicare rule.

Fees for audiology diagnostic tests would increase 14–66 percent; vestibular tests, 66–363 percent; and intraoperative monitoring 53–69 percent under the proposal released by the Centers for Medicare and Medicare Services in July.

Audiology services in hospital outpatient centers are governed by the hospital outpatient prospective payment system; rates for speech-language pathology services in that setting fall under the Part B Medicare Physician Fee Schedule.

Rates for hospital outpatient audiology services are determined by grouping similar procedures—those that are comparable clinically and in resources required—into an ambulatory payment classification. CMS proposes to shift the classification for four audiology procedures, an action usually taken because the median cost for the procedure has increased or decreased well beyond the median cost of the classification. The classification of these four CPT codes (Common Procedural Terminology © American Medical Association) has changed:

  • CPT 92542 (Positional nystagmus test): 60 percent payment increase
  • CPT 92548 (Posturography): 18.2 percent decrease
  • CPT 92552 (Pure tone audiometry air): 335 percent increase
  • CPT 92562 (Loudness balance test): 335 percent increase

Annual shifts in hospital outpatient rates are based on national hospital cost records and other factors, including:

  • Changes in hospital Medicare cost reporting.
  • "Conditional packaging," a new process applied to payment groups that contain certain procedures, including some audiology diagnostic procedures.
  • Inflation.   

The rule was published in the Federal Register [PDF] on July 19. For more information, contact Mark Kander, ASHA director of health care regulatory analysis, at mkander@asha.org or 800-498-2071, ext. 5669.


  

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