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Medicare Part B Payment Cuts to Audiology and Speech-Language Pathology Services

Updated December 28, 2021

Audiologists and speech-language pathologists (SLPs) have faced significant payment cuts to Medicare Part B (outpatient) services beginning in 2021. Although extensive advocacy by ASHA and other stakeholders resulted in legislation that mitigated the 2021 and 2022 cuts, some cuts are still set to return in 2022 if not fully addressed by Congress by the end of the year.

ASHA has engaged in ongoing advocacy and collaboration with CMS, key decision makers—including members of Congress—and other provider groups to find short- and long-term solutions. These activities are a part of our overall efforts to ensure adequate Medicare reimbursement of audiology and speech-language pathology services.

Act now! Contact your Members of Congress and ask them to more fully address the Medicare payment cuts by supporting H.R. 6020/S. 3314, The Supporting Medicare Providers Act of 2021.

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Impact on Audiologists and SLPs

In its release of the 2022 final rule for the Medicare Physician Fee Schedule (MPFS) for Part B services, CMS did not finalize specific changes to mitigate the payment cuts set to return in 2022 for audiologists, speech-language pathologists (SLPs), and over 30 other Medicare provider groups. CMS initially established a calendar year (CY) 2022 CF of $33.59, representing an almost 4% decrease from the $34.89 CF for 2021, and an almost 7% decrease from the 2020 CF, due in large part to the E/M code changes and the expiration of the 3.75% payment adjustment. Following Congressional intervention, the updated CY 2022 CF is now $34.61, representing a 3% increase from the initial CF.

Audiologists and SLPs have also faced other Medicare cuts unrelated to the E/M changes. These cuts, known as sequestration (2% reduction), and statutory "Pay-As-You-Go", or PAYGO, (4% reduction), would have resulted in a 10% or higher cut in overall Medicare payments when added to the CF reductions. Congress recently acted to address some—but not all—of these cuts in 2022 by passing the Protecting Medicare and American Farmers from Sequester Cuts Act (P.L. 117-71). P.L. 117-71 significantly reduces the cuts and phases in the remaining cuts over the course of the year.

Summary of Estimated Payment Changes

CMS estimates an overall net-zero change in payment for audiology services and a 1% decrease for speech-language pathology services in addition to the adjustments outlined above, which means audiologists were facing at least a 10% decrease in payments and SLPs an 11% decrease in 2022. As a result of mitigations enacted by P.L. 117-71, audiologists will now see an estimated 0.75% decrease to payments in the first quarter of 2022, a 1.75% decrease in the second quarter, and a 2.75% decrease in the third and fourth quarters. SLPs will experience an approximate 1.75% decrease in the first quarter, a 2.75% decrease in the second quarter, and a 3.75% decrease in the third and fourth quarters. Keep in mind that the direct, cumulative impact of payment adjustments on individual clinicians or practices will vary depending on several factors, including locality-specific rates and the specific procedure codes billed. It is also important to note that these 2022 adjustments are in addition to 2-5% cuts to audiology and speech-language pathology services that were implemented in 2021. For additional information, please see ASHA's detailed analysis of changes and their impact on payment for audiology and speech-language pathology services.

ASHA’s advocacy efforts throughout this year have focused on reversing these cuts in their entirety and working toward a long-term solution to stabilize Medicare payment policy. While far from ideal, P.L. 117-71 reduces near-term Medicare payment cuts—which could have been as high as 10% or more—allowing additional time for ASHA to work with allied stakeholders to convince Congress to more fully mitigate the cuts in 2022 and to work toward a long-term policy solution. However, clinicians should be prepared for some cuts to go into effect on Jan. 1 if Congress does not pass a full legislative fix before the end of the year.


The 2022 Medicare Part B payment cuts are the result of three separate statutory provisions designed to control federal spending which are 1) budget neutrality, 2) statutory "Pay-As-You-Go" (PAYGO), and 3) sequestration. Advocacy by ASHA and other stakeholders helped lead to legislation postponing these cuts for 2021. However, they were slated to return in 2022 without further Congressional action.

Budget Neutrality

A significant portion of the payment cuts came about because CMS finalized changes to office-based outpatient evaluation and management (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 negative impacts to audiologists and SLPs are higher than usual because of the significant increase in value for the new E/M codes. Although legislation significantly reduced the E/M-related 2021 cuts by 3.75% in 2021, it didn't stop the E/M code changes, so the payment reductions will continue to return each year to meet the budget neutrality mandate, unless Congress or CMS find short- and long-term policy solutions.

Statutory PAYGO

This policy requires new legislation increasing the federal deficit to be offset by reduced spending elsewhere. Medicare payments are subject to this policy, but can't be reduced by more than 4%.


This policy stems from a 2011 law requiring automatic reductions in programs, such as Medicare, to impose fiscal restraint on federal spending. 

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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 prevent resumption of the sequestration cuts and to seek short- and long-term solutions to Medicare payment cuts to audiology and speech-language pathology services.

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 E/M related payment increases for primary care services without the negative impact to other provider groups, including audiology and speech-language pathology.

  • Comment letter to CMS [PDF] regarding the proposed 2022 Medicare Physician Fee Schedule (September 9, 2021)
  • Request for a meeting [PDF] with CMS Administrator Chiquita Brooks LaSure to discuss the payment cuts (July 2, 2021)

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