Policy Analysis: Medicare Alters Outpatient Hospital Audiology Rates for 2014 By Mark Kander Medicare reimbursement rates for several audiology hospital outpatient billing codes have increased substantially in 2014, according to the 2014 final rule for the hospital outpatient prospective payment system issued in late November 2013 (see chart below). Reimbursement levels for several individual vestibular tests increase by 13 ... Policy Analysis
Free
Policy Analysis  |   January 01, 2014
Policy Analysis: Medicare Alters Outpatient Hospital Audiology Rates for 2014
Author Notes
  • Mark Kander is ASHA director of health care regulatory analysis. mkander@asha.org
    Mark Kander is ASHA director of health care regulatory analysis. mkander@asha.org×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   January 01, 2014
Policy Analysis: Medicare Alters Outpatient Hospital Audiology Rates for 2014
The ASHA Leader, January 2014, Vol. 19, online only. doi:10.1044/leader.PA2.19012014.np
The ASHA Leader, January 2014, Vol. 19, online only. doi:10.1044/leader.PA2.19012014.np
Medicare Alters Outpatient Hospital Audiology Rates for 2014
By Mark Kander
Medicare reimbursement rates for several audiology hospital outpatient billing codes have increased substantially in 2014, according to the 2014 final rule for the hospital outpatient prospective payment system issued in late November 2013 (see chart below).
Reimbursement levels for several individual vestibular tests increase by 13 percent; however, the rate for basic vestibular evaluation, CPT 92540 (Common Procedural Terminology,® American Medical Association), increases 4.8 percent. The fee for CPT92586, screening using auditory evoked potentials, increases 60 percent to $128, significantly surpassing the Medicare non-hospital rate and serving as a valuable fee reference used by other payers.
The comprehensive hearing test (CPT 92557) incurs a rare decrease of 15.4 percent, but the rate remains more than twice as high as the Medicare non-hospital fee.
The payment rate for cochlear implantation (including the device) increases by 1.4 percent, and the rate for osseointegrated implantation (with device) increases by 1.3 percent. Hospitals report that although the cochlear device cost is covered in this rate, the complete surgical costs are not.
The hospital outpatient prospective payment system determines rates by assigning CPT codes to ambulatory payment classifications. The codes in any given classification are comparable clinically and with respect to resource use, based substantially on national hospital cost records from two years prior. The 2014 rule changes the classification of several audiology-related procedures, resulting in substantial reimbursement increases or decreases for some of the re-assigned codes.
The final rule for hospital outpatient services also consolidates some hospital outpatient physician office visits from 10 procedure codes to one—and a single payment level. The American Hospital Association has been critical of this decision, stating that this will result in payment levels well below the cost of treating complex patients. Although this regulation does not affect audiologists directly, ASHA is carefully watching this trend.
Codes with an increase of at least 10 percent
Codes with an increase of at least 10 percent
Codes with an increase of at least 10 percent×
 Codes with an increase of at least 10 percent
Codes with an increase of at least 10 percent
Codes with an increase of at least 10 percent×
×
Codes with a decrease of at least 10 percent
Codes with a decrease of at least 10 percent×
 Codes with a decrease of at least 10 percent
Codes with a decrease of at least 10 percent
Codes with a decrease of at least 10 percent×
×
Codes with an increase of at least 10 percent
Codes with an increase of at least 10 percent×
 Codes with an increase of at least 10 percent
Codes with an increase of at least 10 percent
Codes with an increase of at least 10 percent×
×
Codes with a decrease of at least 10 percent
Codes with a decrease of at least 10 percent×
 Codes with a decrease of at least 10 percent
Codes with a decrease of at least 10 percent
Codes with a decrease of at least 10 percent×
×
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
January 2014
Volume 19, Issue 1