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
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
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.
Please e-mail firstname.lastname@example.org
with questions regarding the MFPS or hospital OPPS.