November 2, 2022
The Centers for Medicare & Medicaid Services (CMS) has released the 2023 Medicare Physician Fee Schedule (MPFS) final rule, which establishes payment policies and rates for Part B (outpatient) audiology and speech-language pathology services. Significant policies addressed in this rule include:
ASHA provided extensive comments [PDF] to CMS regarding all these issues in response to the 2023 proposed rule released in July.
The final rule applies to services provided in calendar year 2023.
The following information highlights key provisions impacting audiologists and speech-language pathologists (SLPs). ASHA will provide more detailed summaries of these and other proposed changes through ASHA Headlines and ASHA Leader Live next week. The final 2023 Medicare outpatient payment rates and related information for audiologists and SLPs will also be published on ASHA’s Outpatient Medicare Physician Fee Schedule webpage.
CMS uses an annual conversion factor (CF) to calculate MPFS payment rates. The 2023 CF is $33.06, representing a nearly 4.5% decrease from the $34.61 CF for 2022. The significant decrease in the CF is due in large part to expiration of the 3% positive adjustment that Congress implemented to mitigate significant payment cuts in 2022. Congress must act again to stop the return of the cuts in 2023. ASHA is engaged in ongoing advocacy with Congress and key stakeholders to find short and long-term solutions to address Medicare payment concerns. Bipartisan legislation, the Supporting Medicare Providers Act of 2022 (H.R. 8800), has been recently introduced by Representatives Ami Bera (D-CA) and Larry Buchson (R-IN) to mitigate cuts in 2023. ASHA strongly encourages audiologists and speech-language pathologists to contact their members of Congress and ask them both to cosponsor H.R. 8800 and address the Medicare cuts before the end of the year.
CMS will allow Medicare beneficiaries access to select audiology services without a physician order once every 12 months through use of a new “AB” modifier, reported with one or more of 36 CPT codes delivered on the same date of service when provided by audiologists. In the proposed rule, CMS planned to create a new G-code to replace CPT codes when a service is provided by an audiologist without a physician order. However, in the final rule CMS reversed course on the G-code proposal and selected the CPT code/modifier option based on the specific and detailed rationale offered by ASHA in its comments. While the use of the code/modifier improves the accuracy of audiology claims data and payments, as well as eliminates coding confusion, ASHA finds the restrictions placed on accessing audiology services without a physician order to be arbitrary and lacking any clinical justification. ASHA will continue to advocate for passage of the bipartisan and bicameral Medicare Audiologist Access and Services Act (H.R. 1587/S. 1731), which removes the physician referral requirement completely while appropriately expanding Medicare coverage to include both diagnostic and treatment services provided by audiologists. ASHA encourages audiologists to contact their members of Congress and ask them to support passage of the Medicare Audiologist Access and Services Act before the end of this year.
CMS lacks the statutory authority to maintain the telehealth flexibilities allowed during the federal public health emergency (PHE), once it is over. As a result, coverage of telehealth services provided by audiologists and SLPs will end when the PHE and the 151-day extension ultimately expire. However, the final rule includes ongoing coverage of several CPT codes typically used by audiologists and SLPs through the end of 2023. This means that these codes will continue to be payable through 2023 when provided by a physician or practitioner, or by an SLP providing services incident-to such a provider, even if the PHE and extension expire earlier. ASHA will provide a full listing of these codes in our next update. A listing is also available in Table 12 of the final rule.
ASHA remains committed to advocating for permanent Congressional authority for audiologists and SLPs to be telehealth providers under Medicare.
Initially, CMS proposed two new G-codes for RTM services for use under the MPFS. ASHA opposed the new G-codes because they would have created coding confusion and reduced payment for RTM treatment management services when provided by SLPs. After considering extensive ASHA and stakeholder comments, CMS will not implement the G-codes and will maintain payment for the existing Current Procedural Terminology (CPT®) codes (98980 and 98981) for RTM treatment management services. As a result, SLPs currently reporting CPT codes 98980 and 98981 will see no change to Medicare coding and billing requirements for RTM treatment management services in 2023.
The audiology specialty measure set for the 2023 performance/2025 payment year includes two new measures:
CMS also retained Measure 261: Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness based on recommendations from stakeholders including ASHA.
The speech-language pathology specialty measure set for 2023 will remain unchanged from 2022.
Clinicians continue to be excluded from mandatory MIPS participation if they have allowed charges for covered professional services less than or equal to $90,000, furnish covered professional services to 200 or fewer Medicare Part B-enrolled individuals, or furnish 200 or fewer covered professional services to Medicare Part B-enrolled individuals. Based on these requirements, ASHA estimates that less than 1% of its members are subject to MIPS.