2021 Medicare Part B Payment Reductions

Audiologists and speech-language pathologists (SLPs) were set to experience significant payment reductions for Medicare Part B (outpatient) services beginning in 2021. After extensive advocacy by ASHA and other stakeholders, Congress passed legislation significantly reducing the cuts for 2021, allowing additional time to find a long-term policy solution. Learn more about the reductions, ASHA’s ongoing advocacy, and how you can stay informed.

Latest Updates

Congress passed legislation significantly reducing the payment cuts in 2021.

(added 12/28/20)

The Consolidated Appropriations Act, 2021 (H.R. 133), which was signed into law on December 27, 2020, included key provisions which will mitigate the Medicare fee schedule cuts set to go into effect on January 1, 2021. Early estimates show that H.R. 133 could decrease the 2021 cuts by a total of about 2/3 the original impact calculated by the Centers for Medicare & Medicaid Services (CMS). Although this fix is only for 2021 and does not completely eliminate the cuts, other provisions of the legislation may soften the impact of the cuts further.

ASHA remains fully committed to fighting any cuts to Medicare reimbursement. While not perfect, H.R. 133 allows additional time for ASHA to continue working with stakeholders, Congress, and CMS to find a long-term policy solution. ASHA will provide a detailed analysis of changes and their impact on payment for audiology and speech-language pathology services once CMS provides additional guidance. Please continue to monitor this webpage and ASHA's 2021 Medicare Fee Schedule resources for ongoing updates regarding the Medicare cuts.

ASHA members can stay informed and get involved!

Audiologists and SLPs can stay informed by signing up for ASHA’s Headlines and Take Action e-mail lists, and by following ASHA Advocacy on Facebook and Twitter.

Background

The payment cuts impacted audiologists, SLPs, and many other Medicare providers.

In its release of the 2021 Medicare Physician Fee Schedule (MPFS), CMS implemented a 6% decrease in payment for audiology services and a 9% decrease for speech-language pathology services. Audiologists and SLPs were not the only providers seeing significant payment reductions in 2021. For example, other decreases included 8% for cardiac surgeons, 10% for chiropractors, and 10% for radiologists, among others.

ASHA submitted formal comments on the proposed rule to CMS as part of the public comment period. However, CMS did not substantially respond to comments regarding the proposed payment cuts, which were scheduled to be implemented on January 1, 2021, absent Congressional action. 

CMS must reduce rates to offset payment increases for evaluation and management (E/M) services.

Although Congress passed a 1-year fix that mitigates the cuts, it does not solve the underlying issue that necessitated the cuts. The payment reductions came about because CMS finalized changes to office-based outpatient E/M procedure codes, resulting in payment increases for primary care services beginning in 2021. Every year, CMS must ensure that rate changes 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 payments annually when CMS shifts funding to accommodate increases in payments for other services. The 2021 negative impacts to audiologists and SLPs were higher than usual because of the significant increase in value for the new E/M codes. Although H.R. 133 significantly reduced the 2021 cuts, it didn't stop the E/M code changes, meaning the payment reductions will go into effect in 2022 to meet the budget neutrality mandate, unless Congress or CMS find a long-term policy solution.

ASHA is actively working on this issue.

ASHA recognizes that H.R 133 is a short-term fix and will continue working to find a long-term policy solution to mitigate the potential negative impact of the E/M policy changes in future years, given that audiologists and SLPs cannot bill E/M codes to the Medicare program to help offset the reductions. ASHA is engaged in ongoing advocacy and collaboration with CMS, key decision makers—including members of Congress and the incoming administration's transition team—and other provider groups to find a solution.

ASHA’s Advocacy Highlights

Congressional Advocacy

ASHA engages in ongoing advocacy with House and Senate members and staff directly and as part of a broad coalition of physician and nonphysician groups urging Congress to seek solutions—such as waiving the budget neutrality mandate or holding affected providers harmless—to preserve payment increases for primary care services without the negative impact to other provider groups, including audiology and speech-language pathology.  

• The Consolidated Appropriations Act, 2021 (H.R. 133) was signed into law and includes key provisions to mitigate the Medicare fee schedule cuts set to go into effect on January 1, 2021. (December 27, 2021)
• Sustained advocacy resulted in the introduction of a new bill in the U.S. Senate. The bill, S. 5007, the Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, sponsored by Senator John Boozman (R-AR), would address these cuts by providing relief payments in an amount that will ensure parity with current payment for impacted services for the next two years. (December 10, 2020)
• Following implementation of the cuts in the release of the 2021 Medicare Physician Fee Schedule final rule, issued joint statements with the American Occupational Therapy Association and the American Physical Therapy Association and a broad coalition of physician and nonphysician groups urging Congress to address the cuts by including H.R. 8702, the Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020, in any moving legislative vehicle before the end of the year. (December 1, 2020)
• Signed-on to a coalition letter thanking Representatives Ami Bera (D-CA), Larry Buschon (R-IN), and other co-sponsors for their leadership in introducing H.R. 8702, the Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020. (November 11, 2020)
• Sustained advocacy resulted in the introduction of a new bill in the U.S. House of Representatives. The bill, H.R. 8702, the Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, sponsored by Representatives Ami Bera (D-CA) and Larry Bucshon (R-IN), would address these cuts by providing relief payments in an amount that will ensure parity with current payment for impacted services for the next two years. (October 30, 2020)
• Congressional advocacy resulted in 229 members of the U.S. House of Representatives sending a letter [PDF] to Speaker Nancy Pelosi and Republican Leader Kevin McCarthy urging them to address Medicare cuts to reimbursement for audiology, speech-language pathology, and other essential health care services. (October 19, 2020)
• Coalition efforts led to a letter signed by 161 House members [PDF] to HHS Secretary Alex Azar and CMS Administrator Seema Verma asking them to “engage with stakeholders in establishing fair and equitable payment solutions that address Medicare payment cuts at this time, while at the same time moving forward with policies to increase payments to primary care and other office-based specialties.” (September 24, 2020)
• ASHA’s congressional advocacy helped generate and facilitate a letter signed by 93 members of Congress [PDF] to House Speaker Nancy Pelosi and Republican Leader Kevin McCarthy urging that budget neutrality be waived to stop the cuts for two years while a longer-term solution can be developed. (August 11, 2020)
• Following confirmation of the proposed cuts in the release of the 2021 Medicare Physician Fee Schedule proposed rule, issued joint statements with the American Occupational Therapy Association and the American Physical Therapy Association and a broad coalition of physician and nonphysician groups urging Congress to waive the budget neutrality requirement and stop the cuts. (August 4, 2020)
• Congressional advocacy prompted a letter signed by 46 members of Congress [PDF] to House Speaker Nancy Pelosi urging that future legislation include provisions to stop the cuts. (May 28, 2020)
• Wrote letters from  ASHA's President to Senate [PDF] and House of Representatives [PDF] Leaders urging Congress to suspend the budget neutrality requirement for the MPFS related to the increase in E/M codes. (April 6, 2020)
• 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. (February 5, 2020)
• Signed on to coalition letters calling on Congress stop the payment cuts.
  • Coalition letter from 53 physician and nonphysician groups [PDF] to Congress (June 18, 2020)
  • Coalition letter from 46 specialty societies and professional associations [PDF] to House and Senate Leaders (April 17, 2020)

Regulatory Advocacy

ASHA engages in ongoing advocacy with CMS and the Department of Health and Human Services (HHS) directly and as part of a broad coalition of physician and nonphysician groups to find regulatory solutions to preserve payment increases for primary care services without the negative impact to other provider groups, including audiology and speech-language pathology.

• Submitted comments to CMS in response to the 2021 MPFS proposed rule [PDF]. The comments included ASHA's concerns regarding the substantial negative impact of the cuts on audiologists, SLPs, and the Medicare beneficiaries they serve and offered potential strategies for CMS to mitigate or stop the cuts.
• Following confirmation of the proposed cuts in the release of the 2021 Medicare Physician Fee Schedule proposed rule, ASHA, the American Occupational Therapy Association, and the American Physical Therapy Association met with CMS to express our continued concerns [PDF] regarding the negative impact of the cuts and offer potential regulatory solutions to mitigate or stop the cuts. (September 29, 2020)
• Wrote a letter from ASHA’s President to CMS [PDF], on behalf of ASHA members, to reiterate our concern regarding the negative impact on audiologists and SLPs, recommend regulatory strategies to address the cuts, and request specific impact data for SLPs. (February 10, 2020)
• Met with CMS as part of a group of 11 specialty societies and professional associations to discuss how CMS arrived at the projected reductions and share our concerns regarding the significant negative impact to many Medicare Part B provider groups who seldom or never report E/M services under the MPFS. (January 13, 2020)
• Submitted comments to CMS in response to the 2020 MPFS proposed rule [PDF]. The comments included ASHA’s concern regarding the projected negative impact on audiologists and SLPs, and requested additional data from CMS to support the projections and explain how and why some specialties that do not bill E/M services under the Medicare benefit are most affected. (September 27, 2019)
• Signed on to coalition letters calling on CMS to find regulatory strategies to mitigate or stop the payment cuts.
  • Coalition comment letter from 45 physician and nonphysician groups [PDF] in response to the 2021 MPFS proposed rule offering potential regulatory strategies to mitigate or stop the payment cuts. (October 5, 2020)
  • American Medical Association letter from 102 physician and nonphysician groups [PDF] calling on CMS to use its authority under the public health emergency to waive the budget neutrality requirement. (July 1, 2020)
  • Spearheaded a joint letter to CMS [PDF] from a group of 13 specialty societies and professional associations. The letter expresses our concerns regarding the proposed cuts and recommends potential regulatory strategies to mitigate the negative impact of the cuts. (February 10, 2020)

Need more information?

ASHA members can contact reimbursement@asha.org for questions about Medicare payments or grassroots@asha.org for ways to get involved in ASHA’s advocacy initiatives with Congress.

Current procedure code values and national Medicare payment rates are available on ASHA’s Medicare Fee Schedule webpage.