provided in off-campus hospital departments could be reimbursed at a lower fee
schedule rate. The Centers for Medicare & Medicaid Services (CMS) issued
rule [PDF] for services provided in outpatient
hospital departments paid under the outpatient prospective payment system
(OPPS) on July 25. The rule would affect payment for services provided on or
after January 1, 2019, in approximately 3,800 facilities. Audiology services
are included and paid through Ambulatory Payment Classifications (APCs). Under
the Bipartisan Budget Act of 2015, audiology services is one of several
services that when provided in off-campus hospital departments, the services will
be reimbursed at the lower fee schedule rate opposed to the OPPS rate.
is analyzing the provisions of the rule and will submit comments before the
September 24 deadline.
Price Classifications for Audiology Services
Annual updates to the APCs paid under
the OPPS were proposed to increase for audiology services (APCs 5721-5724;
5731-5735; 5741-5743; and 5161-5166). However, CMS is proposing to include the
APCs, which are applicable to audiology services, to the policy that pays a
“site neutral” payment if the service is provided in an off-campus hospital
department. The site neutral payment policy is a requirement of Section 603 of
the Bipartisan Budget Act of 2015.
For calendar year (CY) 2019, CMS
proposes to increase the payment rates under OPPS by 1.25%. CMS estimates that
total payments to OPPS providers will increase by approximately $4.9 billion
compared to estimated CY 2018 OPPS payments. The only exception to the anticipated increase in payments is
associated with services provided in off-campus hospital departments.
In addition, CMS has asserted that
OPPS has been the fastest growing sector of Medicare payment systems under
Medicare Parts A and B.
Please contact Sarah Warren, MA, ASHA’s
director of health care policy for Medicare, at firstname.lastname@example.org.