January 22, 2020
Updated (February 6, 2020): ASHA worked with a large group of other specialty societies and professional associations to develop a letter to CMS signed by 99 members of the House of Representatives [PDF]. The letter registers the members’ collective concern with CMS’s proposed payment cuts, requests that the agency provide more data regarding how the cuts were determined, and asks what might be done to reduce their impact.
In its release of the 2020 Medicare Physician Fee Schedule (MPFS), the Centers for Medicare & Medicaid Services (CMS) discussed changes to evaluation and management (E/M) procedure coding and payment for calendar year (CY) 2021 and the projected impact of these changes on payment rates for Medicare Part B (outpatient) providers. Due to the congressionally mandated budget neutrality requirement for the Medicare program, CMS estimated a significant negative impact on many specialties—including audiologists and speech-language pathologists (SLPs)—beginning in 2021. CMS projected a 6% decrease in payment for audiology services but did not provide a direct estimate of the potential impact on speech-language pathology services because of the relatively low number of SLPs enrolled as Medicare Part B providers. However, SLPs have historically been included in the category of “Other” providers, which is projected for a 5% decrease.
The CMS projections did not take into account other potential adjustments in 2021 and should be considered for illustrative purposes. However, ASHA is dismayed by the scale of the estimated negative impact, given that audiologists and SLPs cannot bill E/M codes under the Medicare program to help offset the proposed reductions in 2021. ASHA is engaging with CMS, key decision makers, and other specialty societies to seek a solution to the projected impact for audiologists and SLPs. We expect additional details regarding the actual impacts in July, when CMS issues the proposed rule for the 2021 MPFS.
CMS must ensure that the total values for all procedure codes paid under the MPFS remain budget neutral, as mandated by law. As a result, Medicare Part B providers may see incremental decreases in values for certain procedure codes when CMS shifts funding to accommodate increases in values for other services. The latest projected negative impacts to multiple specialties—including audiology and speech-language pathology—are higher than usual because of the significant increase in value for the new E/M codes CMS finalized for implementation in 2021.
ASHA will provide updates on this issue through advocacy news and social media (@ASHAAdvocacy). Current procedure code values and national Medicare payment rates are available on ASHA’s Medicare Fee Schedule website. For questions, please contact email@example.com.