ASHA's Analysis of the 2013 Medicare Fee Schedule Now Available

November 15, 2012

On November 1, 2012, the Centers for Medicare and Medicaid Services (CMS) released the final Medicare Physician Fee Schedule (MPFS) and associated rules for 2013. The final rule includes regulations and rates for implementation on January 1, 2013, for audiologists and speech-language pathologists (SLPs) providing services to Medicare Part B beneficiaries under the MPFS. ASHA's Health Care Economics and Advocacy Team reviewed relevant sections of the 2013 MPFS and developed an analysis of the key issues for SLPs and audiologists.

Issues Addressed in the Analysis

ASHA provides separate analysis documents specific to speech-language pathology and audiology issues. Each document contains details on relevant policy changes, a list of CPT (Current Procedural Terminology © American Medical Association) codes with their national average payment amounts, and useful links to additional information. Rates published in ASHA's analysis reflect the 26.5% decrease that will go into effect in 2013, absent Congressional action.

The analysis for SLPs includes information on the therapy cap, required reporting through the Physician Quality Reporting System (PQRS), new policies for certain speech generating devices (SGDs), and instructions for outcome reporting on the claim form mandated to begin January 1, 2013.

For audiologists, the analysis includes information on new electrophysiologic evaluations and intraoperative neurophysiologic monitoring CPT codes and late-breaking news regarding significant changes to PQRS quality measures. ASHA recently learned from CMS that two audiology-related PQRS measures are being deleted, though this was not originally made clear due to inconsistencies published in the final rule. ASHA is meeting with CMS officials to determine which measures will remain active for PQRS reporting in 2013.

ASHA Resources

The ASHA analysis of the Medicare Fee Schedule for 2013 is available on ASHA's billing and reimbursement website. A summary of key issues will also be published in the December 8 issue of The ASHA Leader. Please continue to monitor ASHA Headlines and the billing and reimbursement website for updates on Congressional action on the rate cuts and the therapy cap.

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