Audiology and speech-language pathology services under Medicare Part B (outpatient) have reimbursement rates established by the Medicare Physician Fee Schedule (MPFS) regardless of provider setting, except for outpatient audiology services and specific speech-language pathology services (stroboscopy, laryngeal function studies, or certain services not provided under a therapy plan of care) provided in hospitals, which are paid under the Outpatient Prospective Payment System (OPPS). Medicare Part B covers outpatient services and inpatient physician visits. Inpatient rehabilitation and diagnostic services are covered by Part B after depletion of the Part A 100-day skilled nursing facility stay or 90-day hospital stay or at disqualification of skilled nursing status.
MPFS payment is determined by the fee associated with a specific Current Procedural Terminology (CPT) code and is adjusted by geographic location. The fee schedule is updated annually by the Centers for Medicare and Medicaid Services (CMS) with new rates going into effect January 1 of each year. By law, CMS must publish the new rates in the Federal Register by November of the preceding year. ASHA publishes an analysis of the new MPFS annually and includes CPT codes used by audiologists and speech-language pathologists, their national average payment amounts, and information related to specific policy changes for the calendar year.
ASHA is the recognized national professional organization for representation of the audiology and speech-language pathology professions in both the American Medical Association (AMA) CPT Editorial Panel and the AMA Relative Value Update Committee (RUC). ASHA's Health Care Economics Committee (HCEC) coordinates recommendations from ASHA members and related organizations in developing new procedures for adoption by the CPT Editorial Panel. The committee also conducts surveys and holds consensus panel meetings to develop data that are presented to the AMA and CMS to develop fees.