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Medicare Payment for Outpatient Audiology and Speech-Language Pathology Services

The Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment System

ASHA provides information on payment for audiology and speech-language pathology Medicare services provided in in all outpatient settings, including in-depth analysis of relevant policy changes and national payment rates. 

Latest Developments

  • Now Available! ASHA's 2021 Medicare fee schedule analyses have been updated to reflect the updated conversion factor and payment rates. (January 8, 2021)
  • The Consolidated Appropriations Act, 2021 (H.R. 133), which was signed into law on December 27, 2020, includes key provisions to mitigate the Medicare fee schedule cuts set to go into effect on January 1, 2021. (December 28, 2020)
  • Please continue to monitor this site or sign up for ASHA Headlines for important Medicare updates.

Get the latest billing and reimbursement news.

The Medicare Physician Fee Schedule (MPFS)

Audiology and speech-language pathology services under Medicare Part B (outpatient) have reimbursement rates established by the MPFS regardless of provider setting, except for outpatient audiology services provided in hospitals. ASHA provides information on the MPFS for audiologists and SLPs, including in-depth analysis of relevant policy changes and revisions to the fee schedule, Medicare Part B payment rules, geographic adjustment calculations, and new developments each calendar year. The Centers for Medicare & medicaid Services (CMS) updates the fee schedule annually for implementation on January 1.

Analysis of the 2021 MPFS 

(updated 1/8/21)

ASHA's analysis of the 2021 MPFS provides an overview of relevant policy changes and calculates national average payment amounts for audiologists and SLPs. This version includes updated 2021 payment rates that reflect Congressional action to mitigate the cuts.

Analysis of the 2020 MPFS

Understanding the Medicare Fee Schedule

The Hospital Outpatient Prospective Payment System (OPPS)

Medicare pays for hospital-based outpatient audiology services under the OPPS. Speech-language pathology services performed in hospital outpatient clinics are billed fee-for-service through the MPFS, with the exception of a few CPT codes not classified as “always” or “sometimes” therapy codes. ASHA provides information on the OPPS for audiologists and SLPs, including an analysis of relevant policies, changes to Ambulatory Payment Classifications (APCs), and rates for implementation each calendar year. CMS updates the OPPS annually for implementation on January 1.

Analysis of the OPPS

ASHA's analysis of the OPPS provides an overview of relevant policy changes and national APC payment amounts for audiologists and SLPs. 

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