Medicare Outpatient Hospital Rule for 2026 Reduces Audiology Values and Modifies Quality Reporting Requirements

On November 21, the Centers for Medicare & Medicaid Services (CMS) issued the final rule outlining payment rates and policies for services provided in outpatient hospital departments. This rule primarily impacts audiology services, as speech-language pathology services provided in this setting are paid under the physician fee schedule as required under federal law.

Payment Updates for 2026

Medicare payments to outpatient hospital departments will increase by 2.6% in 2026. Based on this update, CMS estimates that payments to this sector will be $101 billion, an increase of $8 billion over 2025 payments.

Changes to Ambulatory Price Classifications (APCs)

ASHA is pleased to acknowledge that CMS has incorporated several of ASHA’s key recommendations in the Hospital Outpatient Prospective Payment System (OPPS) final rule APC classifications. ASHA reviewed and commented on CMS’ proposed APCs for audiology-related services and supported the reassignment of CPT code 92579 (visual reinforcement audiometry) from APC 5721 (Level I Diagnostic Tests and Procedures) to APC 5722 (Level II Diagnostic Tests and Related Services) and CPT code 92588 (evoked auditory test, complete) from APC 5722 to APC 5723 (Level III Diagnostic Tests and Related Services). CMS has finalized both of these APC reassignments, consistent with ASHA’s recommendations.

ASHA also supported the addition of new remote therapeutic monitoring codes—98984, 98985, and 98986—for payment under the OPPS. These additions have likewise been finalized in the final rule.

ASHA also expressed concern about the continued placement of CPT code 92540 (basic vestibular evaluation) in APC 5721 and urged CMS to reassign this service to APC 5722. CMS has finalized this reassignment of CPT code 92540 to APC 5722.

All of the above APC reassignments have increased the value of the associated audiology services.

But despite ASHA’s comments and ongoing efforts to ensure audiology services are appropriately valued, the final rule includes negative adjustments of as much as -$149.36 to some APC groups—including audiology procedures.

Quality Reporting Changes

Despite ASHA’s opposition, CMS finalized the removal of several quality measures under the Hospital Outpatient Quality Reporting (OQR) Program, Rural Emergency Hospital Quality Reporting (REHQR) Program, and the Ambulatory Surgical Center Quality Reporting (ASCQR) Program, including:

• The COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP) measure from the Hospital OQR and ASCQR Program measure sets beginning with the calendar year (CY) 2024 reporting period/CY 2026 payment determination;
• The Hospital Commitment to Health Equity (HCHE) measure from the Hospital OQR and REHQR Program measure sets, and the Facility Commitment to Health Equity (FCHE) measure from the ASCQR Program measure set beginning with the CY 2025 reporting period/CY 2027 payment or program determination;
• The Screening for Social Drivers of Health (SDOH) measure beginning with the CY 2025 reporting period; and
• The Screen Positive Rate for SDOH measure from the Hospital OQR, REHQR, and ASCQR Program measure sets beginning with the CY 2025 reporting period.

Questions?

Reach out to reimbursement@asha.org.